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12/23/2003 17: 16 20983251" WRIGHT ENVIRONMP 1L PAGE 02 <br /> SAN J0AQU1N COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> J04 E WEaER AVS.340 FLOOR <br /> STOC KTON.c_A 352c2 <br /> APFIUCATlCN FOR.UNDpRGAOUND TANK RETRCFM OR PIPrNG REPAIR PERMIT <br /> T}1i5 PzRrmf7=?TIRES:O CAYS PROC A-HE APPr,IIVAL DATE. 00 NOT WRITE IN ANY SHADED AREAS.INMCATI!PERUIT TYP BELOW: <br /> —TANK AETPCFT ai�NG REPAtPJgETRCFIT XUNCER DfSKNSSR cNrAIINN/M/EENT REPASRIRETROFTT <br /> •• -`Z -------tl•_ --------------...... .___ I iAG.7S� Cs'K •L CLLT,?r¢YyY^AJy tp y3��s•lYKIS.O/ p�.,, ) �}�Q _ /� �j� - ' <br /> �/ <br /> arcs---------------- <br /> -- a---- �_ �{�J/77�T.�._, --- - - - _-_---------....... n�(..... 7'rA�/.. <br /> ko 77.. .... _�°Q ..... - __--- <br /> ----------- ----------- ..................... .....__1 <br /> 4 _ m- s aD�, .9 56 ---------- <br /> --------------- <br /> I <br /> -=-- - - - -- -Lk)_ <br /> l � -T .......... ...... -------•-- ------ ------ <br /> a ------------ NA7 iNI�S1t__6? )1'rS ►� t.1��; » 1J_9:�. -17_ '...... <br /> 0 ` �/��J I % 5Q <br /> •_~ �jfi lj� J VLL/JJ G\ LLC' ><-6"1501...__: CT.d}S/J�1}= �� ��"/] ---- -, <br /> a -__ 3. ..... TTT$4at .!^.�{.-C..�......... .._..__................... .--._r.J.!_I <br /> a .._.....I--- - `------ ----E -- -------------------- <br /> ----------­ .......................... ............... ................................._.....- ._........._..I--------•-•. -.-.__--•.-I <br /> ......... '•------'-•....................+.................................. f <br /> _ .r <br /> 7'l< 5::9 ; C72 UST <br /> It. <br /> _.�• ±.'I .r ,fr ,Ilf� . i., .r ic.�. I . i .. i ! i li ..r{ i, E,rll ,fl ., ,?.. !ri <br /> MIV57 7F.7rCRN- IL: JIOz7 :'I +.0 :: A� ;C_ 4I-.)z Sd.7' c?.Q4::! :^..C?iT;' �I:,D:>J�Je«' orA-g ;aHS, X:fD vi . <br /> - <br /> ^;US- A£1SQN :V SUC 5, �l.'1N�?, x.s•.� . . . <br /> 'lLt:7`S� SVpJrti; :O uGQ.I'Ex-$ �wna t.A::C;J .:'AS �f :.\:.:?aRv:?..' CCNTF?C-gid'3 ::QLSC Ox �•1RCN'RT.CT:i1G S��sa':L7-:. C.:l::T.�S "'ice <br /> ?OGLCuitt�e A- -!I ?C%�qeZ'�' 'CXX r"A WIZZ-S'. .,:A PSAN:7 IS :.!3=' zIPLOY Pn7sr""5 SI.B-.zZc.' n <br /> ,.........__._..... ......... <br /> ....; .......................................................... ------ •- ...... <br /> BILI. NG iNFt7RMA T 1GN: <br /> r dicate the responsible psr�y to be billed for additional EHD staff time expended beyond perrr-it payment <br /> -,overage per tank, if the party designated below is different than the permit applicani,- e-g. property <br /> ,jwner, the party must ackncimedce this -asponsibiliiy fcr the 'pilling by signature and date relcw. <br /> `J f 12 �.CdrES�.�I.,f Y/>"31[,�1+ /) t phone 99 )_ <br /> .;gnaIure <br /> ;revised 1/31/G2; <br />