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F <br />A <br />C <br />I <br />I. <br />I <br />T <br />Y <br />O <br />N <br />T <br />R <br />A <br />C <br />T <br />O <br />R <br />T <br />A <br />N <br />K <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />EPA Site # <br />SAN ;! A l 1CO <br />�I1 oz e <br />Telephone: (209) 468-3420 Fax: (209) 468-343S <br />11111 111111111111111111111111 • •- r - -• t • • -• •_ _ - <br />THIS PERMIT EXPIRES 180 DAYS FROM THE APPROVAL DATE- INDICATE PERMIT TYPE BELOW. <br />❑TANK RETROFIT ®PIPING REPAIRIRETROFIT ❑UDC REPAIRfRETROFIT ❑COLD START/EVR UPGRADE <br />Project & Telephone #Joe Bagley 367-4800 <br />Facility Name San Joa uin Count Jail1O1e # - <br />Address 7000 Michael Canlis Blvd, French Camp <br />Cross Street <br />• - ! • - • • . a • #i�u aC't�FTiSiQ�� <br />Contractor Name Joseph Bagley <br />•. a.e• <br />ICC Technician's - i r.s• •' <br />ICC Installers Certification Number 5297791- <br />P <br />L <br />A <br />N Plan ReviewerS <br />,iC61 (D21 <br />QUI, • r . � �� <br />icals Stored <br />Tank ID Tank Size Currently/Previously <br />20K I Diesel Fuel <br />with conditions ElDi <br />'ons) <br />JJ <br />Date <br />Data UST Installed <br />• •WillA mi Al• <br />_. •. •1=MZ NO <br />, • <br />K FOR VMICH THIS PERMIT IS ISSUED, W -`-"JL R`"'" <br />OF C, . i' <br />• f <br />' 11 beyond permit payment coverage per tank. If <br />Indicate the responsiv#rl� to be billed for a'dditional EHD staff time expended <br />the party designated below is different than the permit applicant, e.g. property owner, the party must acknowledge this <br />responsibility for the billing by signature and date below. <br />d_ 1/ <br />NAM <br />#4, Lodi, CA 95240 <br />EHZ=38 (revWad 1 IM <br />0 <br />M <br />