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EMVIRMMEW- AL HEALTH DIVISION <br /> + APPLICATION FOR UNOERG* TANK RETROFIT, TANK, LIMING, OR PIPING a 5 PER.41T <br /> THIS PERMIT EXPIRES 90 DAYS FRCM THE APP. AL OATS. 00 NOT 'WRITE IN ANY iZAADEO AREAS. INDICATE PERMIT TYPE aELC.: <br /> -IZITANX REPAIR/RETROFIT TANK LINING PIPING REPAIR <br /> EPA SIT= - I PROJECT CCNTACT L TELEPHONE �, <br /> A FACILITY NAME :1,021-z <br /> 1- l "7 I PHCNE 9 �(�_ f'1 <br /> C ADDRESS L� l CS <br /> LCROSS STREET 1 <br /> i C::N'SRICPERATC PHONE j <br /> C ( CONTRACTOR NAME PHONE j <br /> -r2vq3 <br /> Y COYTRACTCR AOORESS J I CA LI w r <br /> C 4y 1 <br /> OTHER (HMZ..4ATiCN / <br /> i <br /> PHONE A <br /> 2i <br /> PHONE <br />--llIl111ftilI11II1111IlltilI1111 <br /> _ TAAx 10 r TANK Si'c I E:NICALS STCRED t:.:RRERTLY/PRE'/1CL'SLY OATS UST INSTALL=] <br /> 39- f-- I <br /> I <br /> _ i f <br /> '• ll ( ! l t <br /> _ 'P�aCVc AP9R. '.I'i COYC <br /> (TICN(S) O,SAPPQCVE7 <br /> CS� 4T 'JITH C.4DIT:C.YS) (� <br /> OAT= (J <br />�IIIIII!J1II111111I1I11111 llllil1111I111!lllllllllill lllllll!l111111111111 11lfii1111IIIliI11llllilllllllllillllflllllllll <br /> 'Pot 'C MUST ?CRf�RM ALL .CRX (4 AC=RDAMC; '11TH S; CACL'IN S:Y ! ORDI4AN - -- - <br /> C-S, STATS LALS, AND AUL-: AND 2==ULA I:NS OF <br /> -Jc :cRc-RyAC v' SL:: iL'3 Sc3`7i_3. 'R OR`I -USED AG24T'S S:GNAiURE C=Z'ir c5 7HE "OLL_:I4G: ": CC=T.=Y THAT (4 I <br /> _ 4C. F 7%E SRC . .Q M I CH THIS ?E-4I. (V M—:UEO ' SHALL 4CT :.iPLOY ANY PE.?SCH M„ ER - 1 <br /> - .C3;=-' -� c S.T _ :S �� ::.L: 7841 I4 =�C3 'NNS.. AS T SE=:ME <br /> :v _ 5 __ P :( :O:1 -• 'ONTRACOR'S HIR:4G :R SaC:NTRAC::4G S:GRA JRE �- T:.,. <br /> Pcii_;:.04 :F ' ?c:_ ?!ANC= O: 7NE =CRX .CR IC1 THIS P?-3(T ('a :SaUJ, SHAL_ Z�PLCY ?E-SCAB aUc c-T Tv -;CR:ER'S <br /> r f <br /> __:4G irtF-:2MATOA: <br /> .:i C3.9 .fie i?SC.^.ns ::_ --3r:% _e .-.!,f ,Cr Ca t'CCid t PRS-::'.D it3:' .. _ <br /> - �R' 'WOOF.^.CE^ ..eyCr. •rf^..t� 3dyfiie.^.: _CVE.^3Ce .Br :3nlC. t: ..'Ie <br /> tg =:--ar2nc .a2rt ..'.e ...1 aC_t:C r.', _.�. :r^ er7j _saner, re rdr'- - - :• T <br /> .. ail:. _ 7y 57C_ndCL:re am :ate _eicw. •f .Z=S: 3C::.CJt ...:5 .S--'r.S:Ct :% cr <br /> / r <br /> arae <br /> ay ?hone Mt--=g%��N) <br /> icnac:tre '� , <br /> s <br />