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APPLICATION FSR UN--)!:RCRO''JKD -ANK RZrROFIT, K lIP_vG Z`PAIR PENT <br /> 73IS 2r;K. =X?:E£S 90 DAYS FY`f TFT A?PROV1 Da--. DO SOT u;a- <br /> .r 1)t at,: STLADZD ARc.AS. IvJ:GTE PFRt:IT:!'Pf L--LAS: <br /> -- <br /> .TANK .'Z_:_.Oi IT PAP_.G RF►AIR <br /> zi A s rrs = 2 oJECT cowmc`TELE?S1N2 ` <br /> 209 461 -6337 <br /> ? 'ACILZ-Y t—:- G� \ ' <br /> PFSONE 1 <br /> A _ 2 ® .y1$ <br /> { :kDORELi�--S <br /> r r-- <br /> t atoss STREE— <br /> 3 — <br /> 'S i mtrt£R/OPs RA.'A7,Z ! <br /> o, PHONE <br /> c ` "�� <br /> 209 462-6337 <br /> ELITE IV CONTRACTORS, INC. ( mom s <br /> >; 1 ccwlRAc— —R-s 2535 WIGWAM DRIVE { CA LIC 660016 t aAss A C 10,HAZ ! <br /> R { INSCPXR C ` .}�7 �`-1��y t vORS.CCk7P.S <br /> 046-008761 <br /> C <br /> I <br /> T <br /> O I { PHONE 3 <br /> { <br /> R , <br /> ( { PHONE 3 - t <br /> 1Tt1T••.[a 11■7[[Iat1 f[[f.1 t[a.1f ' <br /> �ftaTaaatatr�vK`.D)gaaatataaaLal <br /> !! r--IZ SIZE oiniIGLS STORED cuRRormy/PREVIOUSLZ DATE UST mcT-ALUm <br /> { <br /> ( )I- { 1 <br /> ---1lE!!1(JIlltfill1fill IIlI1lIiI1!)llltl(litliil(llilll(IlllilIlltllOtittill!l_I�IlilllIilltlilllilll[ltillilliltilllllIiilllti� <br /> APPROVLy f[STH t»rmT._=ON tS) OISAP-%OV I <br /> 1-. ATTAC`.II1£;rr urn COxD:Iobw, 1 <br /> DATE <br /> -�I11IIIltfill IIIIIII Ilt 11. il! !1 tIi 1IIHII t !!ilii!!!!111111(N1111it111f1iiJ11lIIIllltiitllllttl Illilli/I-,lllli�illtl <br /> ;.:�L1C:WY f4tT:- ?E:RfORH ALL WORK .N AC:CRD)L*IC= i:B Shtt 7OAOtfIN auay 02-1- <br /> S STATE LA-S. VZD ZU= ;*A aflGV AMOKS OF j <br /> SAN JOAQCrX C3Lx'rT _'EMLIC HEAL-73 S2 RVIC'S. CL1•-29t OR Llc-ENSED ACFI4-S SIG.,tATUR£CMrrlrrES THE FOI.:.aVZNG: -I C9CT:FY THAT 'x j <br /> .z fy_Qft,:PL tiC=OF 'I%X CORK FOt -naCH TSIS 2 -ITT ZS ISSUM' I SAfL NCT cZ,fPIAY ANY PERSON LX-Wcs A KAmim AS TO BECOME { <br /> :w13 RECT"in u.1T::�'Q-S COMPENSATIOe LAWS OF GAL-=..^.AMAXCOttTRlACIOR•S HI2'vG OR SDSCUKZQACIZ)tG SZGxA:Zlitr CEXlriifS TdE F0LSIXZ1L:j <br /> l_'RTIFr -n" L-V THE PERFORrt:-vCE OF --HE VC7CC AOR UXICH THIS P_PMT IS :.SSUE31, Z SHALL EMPLOY Pf:+LSONS SU33m-M uORICER.S I <br /> :;;7ttPil•C;ATION _.AVS u CA1.;ORXXX-- . <br /> YITI.F. <br /> %3 1LLING IfJF() T -IAT (IV <br /> 2ndicate the responsible party to be billed for additional PAS-Em staff time expended beyond <br /> �c_mit payment coverage per tank- If the party designated below is different than the permit <br /> applicant, e_9_ proper<y owner, Zhe party must acknowledge this responsibility for the billing <br /> by signatu a and date below, <br /> Name �t_ lU Cock<CaC}O�address .3� l,;),t e. hone number 2OS- ybk -b3`� <br /> 5=gnature. <br /> �$ 23-0 <br />