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(b77 <br /> TUBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DMSION <br /> Karen Furst, M.D., M.P.H., Health Officer <br /> �.`.•.•(Kt;.rim.;P.• <br /> 304 East Weber Avenue, Third Floor• Stockton, CA 95202 C(qVIRU L,, <br /> 209/468-3420 PERMIT/SERVICES <br /> PERMIT APPLICATION <br /> TO INTERIOR LINE/REPAIR UNDERGROUND STORAGE TANKS <br /> NOTE: ONLY UNDERGROUND STORAGE TANKS CONTAINING MOTOR VEHICLE FUEL MAY BE REPAIRED BY THE <br /> INTERIOR LINING PROCESS. IN ACCORDANCE WITH SECTION 25296 OF THE CALIFORNIA HEALTH AND SAFETY CODE, SUCH AN <br /> UNDERGROUND STORAGE TANK MAY ONLY BE REPAIRED ONCE. <br /> Site EPA # <br /> Tank ID # ,7 -�r�.r�a,�„csceti•.e <br /> Facility Name: ARCS Facility <br /> Address: City: <br /> State: Qtv_Zip Code: c4,s 3 <br /> Contractor Name: S�_Q A-�- Co <br /> Contractor Address (mailing): �n\1 City: <br /> State: CN Zip Code: <br /> Contractor: kN7r Lining <br /> Contractor Address: e S So,,,t-h go x ). Ck City: <br /> State: Jtyt, Zip Code: <br /> ❑ Approved ❑ Disapproved <br /> n'Ap roved with the following conditions: <br /> a <br /> j czx� <br /> Sa'`1 <br /> Date_ -/7-f 1 R.E.H.S. <br /> 74 <br /> 4 JW <br /> ��Ars <br /> A Division of San Joaquin County Health Care Services <br />