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SAN JOA01N COUNTY AIR POLLUTION CONTROL STRICT <br />1601 E. Hazelton Avenue, P. 0. Box 2009, Stockton, California 95201 <br />Telephone: (209) 466-6781 <br />Application for AUTHORITY TO CONSTRUCT and PERMIT TO OPERATE <br />Date: 7Z9Z79 Application Nu 3 <br />An application is required for each operation subject to pe it. <br />/1' a <br />1. PERMIT TO BE ISSUED TO: Business license name of Corpo ation, Company, Indiv 1 <br />Owner, Partner, or.Governmental Agency. <br />Co <br />unty of San 9-Qaquin <br />MAILING ADDRESS: 222 E. Weber Ave., Rm. 500 <br />Stockton, Ca. 95202 <br />ADDRESS AT WHICH THE EQUIPMENT IS TO BE OPERATED: CITY _COUNTY <br />1810 E. Hazelton Street <br />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 in hereby made for.PERMIT TO OPERATE the following equipment: <br />Two gasoline dispensors <br />L9 <br />tee_ /:®e' <br />42 <br />(Continue on additional 8h x 11 Ea ifs2ace 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 11 -$1200.00 <br />8. SIGNATUM OF APPLICANT: TITLE 0 SIGNER: <br />C <br />S. TYPE OR PRINT NAME OF SIGNER: <br />A. J. Musil <br />NAI-fr,: TELEPHONE NO.: 944-2404 <br />Va I i d -a t ioll. Use only <br />Fllillj.� Code: <br />i"'ite yliiug P4-' Rene ived. <br />