Laserfiche WebLink
• <br />ccRVICE REauEST <br />• <br />Type of Business or Property <br />BLLM PAM <br />FACILITY ID 0 p <br />0W 3 <br />40 <br />SERVICE REQUEST 0 <br />SR 00 3 0 10 <br />Mini Mart <br />FA <br />PHONE a� a,� <br />BUsmEss NAME <br />SAN JOAQUIN COUNTY <br />(20)9-754-1808 <br />BILLING PARTY a <br />OWNER f OPERATOR <br />FAX <br />MALM AOMM <br />Woolsey Oil Company <br />2S <br />( 2 9-754-5726 <br />P.O. Box 950 <br />FAcL rY WE <br />CITY <br />Norms 76 <br />San Andreas <br />8t�tvltt:Cl>o� ... ' ` q {0 <br />-P I E: '2-3 ; <br />F*e Amount ,--� <br />Amount Paid <br />Payment Date( b 7s <br />paymeMType <br />SiTEADWSS 633 <br />E <br />V i c t o r Rd. <br />WWvv4dd <br />Juibf <br />SYM armbv <br />ClrWia <br />SMMtNrM <br />n <br />Mailing Address (if Different from Sits Address) <br />CrrY <br />STATE Zip <br />Lodi <br />PHONE 1!1 <br />APN <br />LANG UsE APPWCATION # <br />(209-948-9412 <br />PHoHa #2 <br />BOS DwrWr . <br />LOCAT N Coot=.:...; . <br />rnr &n nv, c,.vw_r wp, <br />BI! I ING ACK OWLEDGEUEHT: k CIe wdersipW property or twskon owasr, opwaw or aulbod=d awd of saaw. &*WNW* ills) nt 311s w4hr Project speeft <br />ft= HE&yH SEMMS E* n mmENUL HEALTH oNoM hourly dwgm wmo=bd will Ills projW or sr tKt wil bs baled b me or my bwskuN as ktWWo on t6 t m. <br />I also w* I neve prepared ft Wka*m and that Ile work to be ps Wmed will be done in aaooldXM win al SAN JoAam CWM Ordilara Codes. Stan &%% STATE NO <br />FEUEAALIAW <br />AmjQ sIGNATuw Keith A. T a l l i a DAM 6/17/02 <br />wr <br />PROMTYI SUPIEW OWNER OPERATOR/ MANAGER O C;IHERAUhOMAGC ixgv, P n t --=f n t r a r fi n r <br />rAvwrwru$Wfr@{MpeltTLpvdof -fratsfa►b>tpMNgWW Till* <br />AUTHORIZATION TO RELWE Lff0R °TION: When appiable. l the owmr a opwatar oftlw pmp" babd Wills above sib addrae, herebp aur Oft'W nMsse of <br />any and all mvift gwoedarlal data arWW snvNorar W9&ft Oe isaessnWd Inbingft b sn SAN JOAGW COUNTY PueW HEALTH SERVICES EwNWMWTAL HEALTH D vOofi as soon <br />--A .. m. � fi , a is rArsit WA M " or my rwreaeraa&C <br />TyPt:oFSEwcEREmnM:Verify proper <br />BLLM PAM <br />REQUESTOR <br />Keith A. Tallia <br />JU�� g2®02 <br />PHONE a� a,� <br />BUsmEss NAME <br />SAN JOAQUIN COUNTY <br />(20)9-754-1808 <br />%W,P-r <br />FAX <br />MALM AOMM <br />APPROVED ey: 7. <br />2S <br />( 2 9-754-5726 <br />P.O. Box 950 <br />Assam T0: F <br />CITY <br />STATE CA IJP 95249 <br />San Andreas <br />BI! I ING ACK OWLEDGEUEHT: k CIe wdersipW property or twskon owasr, opwaw or aulbod=d awd of saaw. &*WNW* ills) nt 311s w4hr Project speeft <br />ft= HE&yH SEMMS E* n mmENUL HEALTH oNoM hourly dwgm wmo=bd will Ills projW or sr tKt wil bs baled b me or my bwskuN as ktWWo on t6 t m. <br />I also w* I neve prepared ft Wka*m and that Ile work to be ps Wmed will be done in aaooldXM win al SAN JoAam CWM Ordilara Codes. Stan &%% STATE NO <br />FEUEAALIAW <br />AmjQ sIGNATuw Keith A. T a l l i a DAM 6/17/02 <br />wr <br />PROMTYI SUPIEW OWNER OPERATOR/ MANAGER O C;IHERAUhOMAGC ixgv, P n t --=f n t r a r fi n r <br />rAvwrwru$Wfr@{MpeltTLpvdof -fratsfa►b>tpMNgWW Till* <br />AUTHORIZATION TO RELWE Lff0R °TION: When appiable. l the owmr a opwatar oftlw pmp" babd Wills above sib addrae, herebp aur Oft'W nMsse of <br />any and all mvift gwoedarlal data arWW snvNorar W9&ft Oe isaessnWd Inbingft b sn SAN JOAGW COUNTY PueW HEALTH SERVICES EwNWMWTAL HEALTH D vOofi as soon <br />--A .. m. � fi , a is rArsit WA M " or my rwreaeraa&C <br />TyPt:oFSEwcEREmnM:Verify proper <br />operation of new line leak detector <br />COMNENTs: s T f(. i n u, �' <br />U Py � <br />PEC Neo <br />R <br />JU�� g2®02 <br />SAN JOAQUIN COUNTY <br />%W,P-r <br />INSPECTOR'S SOM <br />CONiRAGTOR�'s1S'16NATURE: e t A. s. <br />DAA' <br />APPROVED ey: 7. <br />Ewt oyESif: �i <br />Ip " ` <br />Assam T0: F <br />EmLO M <br />DATE <br />Dao° Sarvke Comp (It aksady completed): <br />8t�tvltt:Cl>o� ... ' ` q {0 <br />-P I E: '2-3 ; <br />F*e Amount ,--� <br />Amount Paid <br />Payment Date( b 7s <br />paymeMType <br />4rvoicelt <br />CheckB -7-7R <br />WWvv4dd <br />n <br />