Laserfiche WebLink
• P7f11l2005 13: 28 91E9277344 CHAhIPION PT INC• PAGE 03 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL. HEALTH DEPARTMENT <br /> UN E Yui AV9.I'a FL40A <br /> STOCKTON.CA 96202 <br /> APYLICATK7i�ROR UWARMOUNO TAW RETROFIT,OR PPM Rr-PA A PCRW <br /> THIS peF"T EXPWS Yo DAYS FROM THE APPROVAL DAIS. 00 NOT WRITE;N ANY SKAW AREAS.INO"75 PERMIT TYPE BELOW: <br /> TtJ�Mc RE fRO"T_R+PINn REPAIMEMOFIT—UN061A OtOW MR CONTAIN►=NT REPAARFMII O T_ - -------- <br /> ----- ----=-----.---- ------------------------------- _„------ --._....'---- <br /> CPA SITE t PROJRCT CGi117ACT 6 :'ttt.AOlIOtQB W �`_..('�„!� •�,� <br /> ----------------------------------- <br /> _-------- -w-. 1------- D+c__ �...-. . _ - - <br /> r , rACILITI NAM _ p tE a `r <br /> +-AD°Ra._.__�J ! ..^ll _ _ - --__ -------_- ---------------n---------- ��l--- - -a_�,.--------- <br /> I +- <br /> ' L 1 CR09H ;TREE? _ _ __ <br /> 54 <br /> f- )� <br /> CO CMNAME + (V vSlMk <br /> ------------------------------------------------ <br /> --------- <br /> --------- --...; <br /> y 'IN CONTRAL70R JlpgkriBa l9 ^-_ -- - - _ __.__-�.�„L2C-p- � a-^JCLPR®.-..._ `--�---......�' <br /> R I YN80RRR''�JI .1160-1 .. '�I�. s�..A.7f O <br /> C yOTIiER Il�rnotuUlr2<Xf as .,..----------------1---------------- <br /> T <br /> PHONE b' ------------------------ <br /> Tj NK I:;'Y ---------- -- - <br /> TANK 9228 • cxle:aICPJ.S 5,Z-'Or ^ <br /> 1t� Gt1Rf![1TLTi PR>r4YQt16LY DATE.tMT 11CC'IALLLD <br /> ,19- , <br /> T i 30- <br /> A 39- <br /> ' It- , <br /> _ - - ' .. ': <br /> .!1it.,,., : •: <br /> y AFPliW1¢+ APPROMW xFTn CON3[l±0lfla} DEGARTIMW <br /> A ATTACORMT *172 CMITIOW0 <br /> m PLAN Rmrl�arsRt SME_;— � O <br /> •---:lt.!{:;14;7,11!:;';;; I ,,;III;;S;'.11'.t.ll...1”'I;:;;',.. .....,, ,,.�,1{111,'�11�;;;:'I„'I!II` :i,111 <br /> APPLICA11t MIISI' PERFOW ALL NO RK IN ACCOR.RA� x;T11 SAN -IGM=R CPUNW 011DIt9lNCB3. fdTA'F'8 LAf1E, i+ND RUT.R9 RPb vs[RnArID68 OF <br /> SAN JOAgpsR lt"TY, BRV: Ci RC9R"'ML X&RI'TH DCOARTNCKT. I-AM31 OR LICEIS A$RWT'9 STO-AATURE CF.RT;4n” TRE FOLL vl=- CSR'lS PY <br /> THfe7 *NTVg 7ERF0RMANCE OP THE WORK FIIR ivrt = TRIS pMj-, I3 ISS794+ I SHALL NOT ..RxPIOY ANY Pta'RSON T.R A77Gii A NAM=AS ?C7 <br /> 8B9�-H. Mii4"th, To WORIMRIS COMPMOATIOM tim Of CALIPrMzA.- WMTAA=R'S RIRYNC �3R 3119C0x7.RAC=MC SIGiQ4=z CWMPI89 TRB <br /> 06Li.CW-44: --1 C8R"Ir>Y THAT IN THE BR&PORmRCR OP THE ROAR MR WnCR Twit PSRMIT SS 'XOMMV, I SHALL F.MP.LOT rrr.RSCMS OWTROT TD <br /> RVR'j='9 4xmp"SATION LAN$ OF CAL,LTftN%A." <br /> avPLxCANP 9 9i6MATURft, ._. - .___ _ �, II'TIE OXTR <br /> ..-_._.-• ---------------- ------------------------------- _-- + <br /> BILLING INFORMATION: <br /> Indicate the responsible party to be billed for additional EHD 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 responsibility for the billing by signature and date below. !P}] <br /> Name-3 Address �'' l �'� 1-ti --T4' Phone# '�)T► <br /> Signature w -- <br /> EH230038 <br /> (revised 1/31/02) <br /> nAL c.i (.lam l E 04.) 071b t l t7tj , <br />