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'mENVIVONMENTAL <br />HEALTH DEPARTMENT <br />304 East Weber Avenue, Third Floor, Stockton, California 95202 <br />Telephone: (209) 468-3420 Fax: (209) 458-3433 <br />THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE INDICATE PERMIT TYPEW <br />' BELOW. <br />UTANK RETROFIT UPIPING REPAMETROFIT ` UDC REPAIR/RETRORT <br />BILLING INFORMATION: <br />Indicate the responsible party to be billed for additional END staff time expended beyond permit payment coverage per tank. If <br />the party designated below is different than the permit ap licant, e.g. property owner, the party must acknowledge this <br />respon " 1 ty for the billing) igna re and date below. <br />l /- <br />NAME _'n HONE <br />EH230038 (revised 8/8106) <br />N <br />r • a <br />Facility Name <br />R <br />14 <br />• <br />Chemicals Stored <br />(See AttachmentT Conditions <br />Plan Reviewers Name— D, <br />APFUCANT MUSTPERFORM ALL WORK IN ACCORDANCE Wrr+i SAN JakQUIN CaKrY ORD�S. STATE LAM. AND RULES AND REGLILATIONS OF SAN <br />JOAQUIN COUNTY, ENVIRONMENTAL.. - - OWNER OR UCe4StD AGENTS SC444fUREE- • • CERTIFY <br />TFIE PERFORMANCE OF THE WORK FOR VMICH THIS PERMIT IS ISSUED, I SRALL NOT EMPLOY ANY PERSON IN SUCF! A MANNER AS TO BECOMESUBJECT TO <br />WORKEWS COMPENSATIONLAWS OF CALIFORNIA-" CONTRACTORS HRINGCA SUBCONTRACT04G SIGNATURE CERTIFIES T14E FOLLOWING: "I CERTIFY <br />THAT <br />•f;T�H�E <br />7 <br />... r .' %_ <br />BILLING INFORMATION: <br />Indicate the responsible party to be billed for additional END staff time expended beyond permit payment coverage per tank. If <br />the party designated below is different than the permit ap licant, e.g. property owner, the party must acknowledge this <br />respon " 1 ty for the billing) igna re and date below. <br />l /- <br />NAME _'n HONE <br />EH230038 (revised 8/8106) <br />N <br />