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VIRON&NTAL:.fjE f <br /> JAQ . .,C . <br /> 304-East Weiier Ayenue ,Tl*cl Floor,Stockt®ni,California 95202 <br /> Telephone: (209).468 3420 .lFa : (209).,468 3433 . . <br /> AfyPLICATION.FOR UNDE tCROUNp S7'ORAGI STORAGE. 'ETRO-1;OR PIPING REt A(R PERMIT <br /> TtI1S PERMIT EXPIRES 90 GAYS FROM THE APPROVAL DATE. INDICATE PERMIT TYPE BELOW. <br /> DiANK RET RORT oPIP.wG REPAIR(RETRO ' <br /> F.:� EPA Site# <br /> Telepho <br /> IjUDC REP.AIRMETROFIT <br /> :A ` <br /> Project(yontact& ne# <br /> C Fad'lit 'Name. <br /> Phone <br /> Air <br /> I Address <br /> -i-c _ <br /> Owned operator.. III <br /> o: Cotrtraior Name '�z Phone# <br /> M, =.. .. ' .• .e .s !?hone: <br /> T CoptiacrAddress �j <br /> R <br /> SEC1C CA C is#�Ql (J' Class t <br /> A InSU(Lf <br /> `• •Wprk Comp# " .. . � _ <br /> T. ICC Techrrician`s Ceitirwafron,jtt tuber <br /> O .Expiration Date <br /> R ICC Installers Cer4ticationManber Expiration Date . <br /> Tank lD .. . nk Size <br /> Cheinica�s`Stored <br /> Ta - <br /> riff ?evioasly <br /> _ Rai UST.Instatai <br /> PApproved <br /> roved.with condi#gns <br /> Disapproved <br /> A ; (See Attadhtnent With CDncftfis) <br /> N Plan'Reviewers Name <br /> Date t <br /> �M'PLIt tI NIt1SSTT I' CNtM ALL <br /> wow-IN-ACCORDANCE WITH;SAN JOAGIOIN CQlRJ7I'ORDINANCES STA E LBWS AND:RtJLI=S SNE?T2EGt/I 4T10NS.OF SAN <br /> JOAQI� l CAUN(Y B�TAL H-PLTft*D0WU*IEN OI!YfJEt-OR 1:�CJ*trlsEb AGEM'S.Si(�VATUI�(3ERTIFlES THE FOL1017YiNG 'I CERTIFY THAT IIV <br /> i FSE Rl�RF(�RMtANCE.OF-7tl WC##GFOR WH(CH 7tgS PERMIF IS iSSWEU;I SHALL NOT EMi oy-ANI'PEFtS(3(V Mt SACH A MA�NERAS TO BE< ME?St1B1ECT TO <br /> W{1�t R'S CUMIyEAI�ATJOPI.LAWS OF C,gLiFORNG4" OONTRACTOM WIRING OR.SCBCON•FWgCT' SlGf�4T-SU .CERTIFIES THE FT3t1 O1NlNG.`ry•( R1IFY .: <br /> i AZ�+L7�lE PEl DE2R>b3Nf�E OF TFC WPRKFOR WHK:N THIS PERMIT IS I IUEO'1 Sb1AL1 EMP60Y FERS SI JEC7 !O WORKER <br /> OF CALIFORNIA" <br /> _.' <br /> Mibw <br /> ;. ,. <br /> Al 11 1 A MY <br /> Date . <br /> G-i. FORMAnON; <br /> idi�ate the nsible <br /> p <br /> po Witty to be b fled addfilne <br /> ona statflpe�3dedzbeyond„perrnit=paymrt c� 1 <br /> ate �4'.-Mme>eTi l TaWe <br /> - anus .a 60"1011110”asibipiag by signature'ansa date below <br /> • <br /> "�anr� u - <br /> ---+t-- iTIE I +1P.HONE# <br /> T <br /> t V4 4 A <br /> 3' <br /> SIGPlATIiRE <br /> EH230038(revised I;Lp/06) <br /> _ <br />