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FEB 14 2001 7: 14AM UNTTED GAS 209 936 0048 p. 4
<br /> 92/11/2995 12:49 209464; VALUED FNGINEERTNG
<br /> PAGE 04
<br /> SANI JOAQUIN COUNTY
<br /> ENVIRONMENTAL HEALTH DEPARTMENT
<br /> 3W E wrrnER AVE,a"0 PLOW
<br /> STOCKTON,CA 91202
<br /> APPLICATION FOR UNOWPOWNCI TANK FliTROPIT,OM MPINa REPAIR 109.111M4T
<br /> TM"FERMIT EXPIRU 90 DAYS FROM THE APPRDVN_DATE. 130 NOT WRIT[IN ANY SNAKED AREAS,INDICATE PERMIT TYPE NlLOW;
<br /> ZTANKIIETROFIT -—' PWMO REP'A4VRGTROF(T ._UNDER DISPENSEFI CONTAINMENT REPAIAIRETROPIT
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<br /> I SMAT T11 -mr. rr.Itroomm or To 110TR rim MIIICR TRX! P,ARMTT 19 UJIU D, 1 SgA1.1. NOT EMPLOY All 4RRAO4 1N WICH n MAWR AN TV i
<br /> IIRQ n GIlRJPCS TO 111111Kwtl'9 CWT,NOATIOV 7•116NS OR rA%JVORATA,1' COWILAC M19 111AINQ DR 1WCMTRnC7'1M6 RThRATUR6 rRRTIPIGS TWIS I
<br /> rl'1l•1,.O1t!J.(11D; ",T ::1SR:1'11t)r TFIAT 31 TI19 t'AIIfOUt'711T+CR OF 9a' NOAK VOK 14111fiN T1Ixd VARMIT t9 j¢R11M1D, 1 valp,, KNMAAY rBKfON$ Aviluli; , 'fA
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<br /> BILLING INFORMATION:
<br /> Indicate the rosponeibie party to be billed for additional AHD staff time expended beyond permit payment
<br /> coverage per tank. If the party designated below Is different than the permit applicant, e.g. property
<br /> owner,the party must acknowledge this ree:pcnaibillty for the billing by sI nature and date below.
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<br /> Name k_ ddresls P,01 at-11311p,Tra phone# b
<br /> Ignetore_,
<br /> EH230038
<br /> (revised 1/31M)
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