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Jul, 10. 2008 4: 17PML"J`West Star Environmental, Inc, No. 9034. 1— <br /> av i fi•nntonra I n . $ <br /> IL M <br /> EIVVIR Raft <br /> SAN <br /> JOAQUIN V 4,O& <br /> 6Q0 East Maio Scree St �,gA�q< � <br /> QcktoN Canfo rnia 95202 <br /> Telephone: (209)468x3420 Fax: (209)468-3433 <br /> AP"'LICATION FOR UNDERGROUND STORAGE TANK RETROFIT OR P <br /> THIS PERMIT�7f OtESS 480 DAYS FROM THE APPROVAL OATZINDICATE (PING REPAIR PERMIT <br /> LJTAN11 RETROFIT f IPIPIMG REt'A1R/Rr.TReF!•f IW �R �8Ct0Y6r <br /> r..•��` r �stJfx REpAIR/RCrROFIT i i <br /> F I EPA She* COLD START/"UPGRADE <br /> A r .—......_.: Project Contact&Telephone#,�fplh <br /> - <br /> C 1 Facility Name �07� <br /> 3?8 <br /> i Address g $3g e�561� <br /> r <br /> � T Cry Street <br /> y ownedo oeratar 1� Phone# <br /> C raaar Name C � V• ,. ..�� w*m,a# Z -1-;7 7. 37�' <br /> Contractor AQdressl Gl.�. ,�I!'/ltlr' Y /U CA LIc# v(�, /4/®-1 <br /> AInsurer c, <br /> vuanc c®mr!# �( -7�/! <br /> T ICG Technician's C - tion Number 7 ® _ E on Date <br /> a <br /> R ICC installer's Cern tion Number <br /> j Expiration Date <br /> Chemicals <br /> I I Tank ID# Tank Size Stored <br /> Cuurrrently 'ausly <br /> Date UST Installed <br /> IIII � <br /> i T C, r <br /> A <br /> LIApproved with wrlditions !Disapproved <br /> p _(Approved <br /> (See n-ent With ConcNons) <br /> A <br /> N Data <br /> Plan Reviewers Name-- <br /> RULES <br /> LAWS' <br /> ApFt(CANT INt7ST PERFORM ALL AL WEALTH DEPAR�AENTTOwNER OR LIC9NBEUD AGENT&SIGNATURE oWMFIES THE OLLow►raG -1 CER T�,TIN 1 <br /> JOAQUIN COUNTY, EnMRONMt[rNTAL <br /> UBJECTTO <br /> THE <br /> P E FoG -E O ON VWR OF tqHICH <br /> ORNIAS POt}N 7TRAC®Ptd ttIRINo OROR SUBOUNNTRACnNG SIGNATU E CER INE THE FQLLOVA GRASTO S'i CERTIFY <br /> THAT IN ,S oMpF SATI NLA��� <br /> CE OF THE��FOR�I�THIS pml r I$t$$1JED,1 SHALL HuhPLfn'PERSONS SUBJECT 70w�ORKt R'S COMPENSATION LAWS <br /> PERF <br /> Or CALIFORNIA," (� ��'� f" D�ot2✓"' "'T - U �, <br /> asaurxls s;gnalur BILLING INFORMATION_ oavermge per <br /> ment <br /> Indicato the responsible party to billed tali additional it staff time expended�Yown®�the pit grty must acknowledge kthis <br /> the party designated below i$ d'dte�rent then the petrnit applieeM. e.g. P <br /> responsibillfty,for the tilling by signature sed date below- <br /> A, .-1 1 TI'TLF PHONE K <br /> NAME <br /> ADL)ftEBS a <br /> n '" <br /> �r �,o A,4 <br /> .. � � � � <br />