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e <br />304 East Weber Avenue, Third Floor, Stockton, California 95202 <br />Telephone: (209) 468-3420 Fax: (209) 3433 <br />THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE INDICATE PERMIT TYPE BELOW <br />ANK RETROFIT UPIPING REPAFJRETROFIT LJU2,C REPA)RMF RO�FIT � <br />[F-1 <br />Project rC,ntct : Telephone�iItil <br />11 <br />� M OF-• <br />+ <br />.. IMA <br />HIT r A <br />�� <br />Y <br />901M <br />, <br />-/_ <br />v <br />CICC <br />Technician's Certification Number <br />f0 <br />•y . _ - - •.• I.I.: I <br />': •.: t: , <br />iz <br />BIWNG INFORMATION. <br />Indicate the responsble party to be billed for additional EHD staff time expended beyond permit payment coverage per tank. If <br />the pa designated below is diffe nt than the permit applicant, e.g. property owner, the party must acknowledge this <br />r <br />Nesp• srb for the bill' 4 signatu d d below. <br />® ) �� t/ dingy PHONE ./ r <br />AM <br />EH23DO38 (revised 8/8/06) <br />1 <br />