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uaoo•I;6•nlvann//:d}}q :}lslA 'uol}ewJo}ul aJOW god jamas xej jeNew)(V� IdE) Aq peAlaoaJ Senn xe} slgl <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />SAN JOAQUIN COUNTY <br />1868 E. HuzeFton Am, Stockton, Calftmia 98205 <br />Telephone: (209) 468-3420 Fax, (208) 468.3433 <br />APPLICATION FOR UNWIRGROUND STOMGE TANK <br />RETROFIT OR PIPING REPAIR PERMIT <br />7"19 pSRM1T EXRIRES 190 DAY$ FROM THE APPAOVAI DATE. INDICATE P$RMIT TYPF 9fiWW1 <br />0 TANK RETROFIT Q PIPING REPAIRMETROPIT CI UDC REPAIRlRET'ROFIT ❑ COLD STARTI@VA UPGRADE <br />Indicate the responsible party b� be billed for additional EHD staff time expended beyond pyrml payment omrage per tants. If <br />the petty designated below is different than the permit applicant, e.g, property owner, the party must acknowledge this <br />responallbbilky for the billing by signature and d1te below. � j, f <br />AlAfutE C Jl TIT O \.SC,� . PMONRIN �d� ��4 �/� "I t? <br />EH230038 (revi99d 07.17.2014) <br />2 RF;(;EIVED <br />APR 0 2 2015 <br />Nd 9t7:9Z:£ 91.0Z/0£/£ :a1ep L/l :abed umou>lun :ward ENVIRONMENTAL. <br />14=AIW r1CDWnAC" T' <br />