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SAN ,.r .': IN COUNTY AIR POLLUTION CONT6,...e (STRICT <br /> 1601 E. Hazelton Avenue, P. 0. Box 2009, Stockton, California 95201 <br /> Telephone: (209) 466-6781 q q <br /> Application for AUTHORITY TO CONSTRUCT and PERMIT TO OPERATE <br /> � <br /> Date: 7/9/79 Application Nu <br /> -------------------- <br /> An application is required for each operation subject to pe it. <br /> 1. PERMIT TO BE ISSUED TO: Business license name of Corpo ation, Company, Indivi 1 <br /> Owner, Partner, or Governmental Agency. <br /> Countv of San Joaquin <br /> 2. MAILING ADDRESS: 222 E. Weber Ave. , Rm. 500 <br /> Stockton, Ca. 95202 <br /> 3. ADDRESS AT WHICH THE EQUIPMENT IS TO BE OPERATED: ( CITY ( ) COUNTY <br /> 1810 E. Hazelton Street <br /> 4. GENERAL NATURE OF BUSINESS: <br /> County Government - Public Works <br /> 5 . EQUIPMENT DESCRIPTION: Pursuant to the provisions of the State Health and Safety <br /> Code and the Rules and Regulations of the San Joaquin County Air Pollution Control <br /> District, application is hereby made for PERMIT TO OPERATE the following equipment: <br /> Two gasoline dispensors <br /> n �w�r 778 <br /> Continue on additional 81I x 11 page if • ace above is insufficient.) <br /> 6. TYPE AND ESTIMATED COST OF BASIC EQUIPMENT: <br /> 7. TYPE AND ESTIMATED COST OF AIR POLLUTION CONTROL EQUIPMENT: <br /> Air Resources Certified Phase II -$1200 . 00 <br /> 8. SIGNATU OF APPLICANT: TITLE 0 SIGNER: <br /> C <br /> 9. TYPE OR PRINT NAME OF SIGNER: <br /> A. J. Musil <br /> NAME: TELEPHONE NO. : 944-2404 <br /> Validatioq_•(A.P,C.D.) use only <br /> Date Application Received: I ) � ' Imo` u ! I I I ! Filing Code: &A. <br /> Date Filing Fee Received: �LIU <br /> 5A1 ; I: ^ ;"IPd I ( '^\L <br /> HEALTH DISI ,?ICT <br />