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02/26/2003 14:23 91637- 2 WALTON ENGINEG PAGE 06 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E"Wt AVE.P FLOOR <br /> STOCRTON,CA 95202 <br /> APPLICATION FOR UNDERGROUND TANK RETROFIT,OR PIPINI2 R19PAIR PERMIT <br /> THIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL.DATE. DO NOT WRNI'R"IN ANY SHADED AR@AA INI?IG4TE PERMIT TYPE MOW; <br /> ---TANK RLYI@O!'IT _PIPINQ REPAIRiRETROEIT -XI-UNOC-R DiSP mavt CONTAINMENT REPAWREMPIT <br /> ..r.....I SM 9 - P- t- <br /> ... .^ ----------------- ---- ----- - -----^------- - ---SONS#••• -. <br /> �l lC I&OP6 b UTA L'r*04 4714 - j),II 113- <br /> L. <br /> i -----------^--- --------------------------` r.rrr-n..................r.....r..------------------^o ----------------„i....... <br /> I <br /> ! 2 I PAC iry tm Q N t e. IcT'o A 4 $9 1 gra# <br /> IA *---- ----------------------------- --------------- I <br /> I = I - ZiS-v 0'_ r-o-F,t^**r Sr , srocors►t Ca 9ra.or I <br /> k I .............^ -- ,.. <br /> -------------- rrr---------------. -r-------------------,--.-------------- -n.......1 <br /> I <br /> I r <br /> -----------------------------------------------r...........----,^^.......-.......... r^.,.nw.-rr_-_ _.w..r-�---- ..rr-- <br /> T ; 0WM/0P c�t1L S T010 1111r>~z ter, C ► aet -------! <br /> Ixl I S%10 *6 $ � - <br /> i-_-A----------------------------------------------- <br /> io * ( Pxi -n­----------------- <br /> C <br /> 3 <br /> I axmmcn NAHIjA,t,TG �C . <br /> ------------ - - rri ...................^ *---- �� ------------ <br /> W. <br /> + dOATR AdASBT P_p. oK (pL <br /> -- - - - Z t —i2 r r t-r•-•--• <br /> ! <br /> $ ttAl�- <br /> 1 A I---,-.-..rr_r ........- ----------- i <br /> ! C I �� YIITCRtMTION f <br /> T4---------------­----------.-.------------- <br /> 01 PH=41 <br /> Ri--------------------- ------------ -^---------------,-------------------^-.---------f.........., ........ -.------------I <br /> IIIIIII111111lIIIIIIIillll1111!I------------ - - -----------------------------------------r---------------^-------------------I <br /> I i TMM ID b I xRNAS 8zz8 i awcew aTORED CUMMMY/15RW70USLY I DATE MIT IIiSTALIEG I <br /> I i 39' t O O +► 0 4f we . 1 I <br /> I TI 99-._ Q L f3f s o o ! 4 Lr Z I-._.-. 9 P <br /> I <br /> I P <br /> I 3B- <br /> •---III(1111111ililfillllllllilllllIi,IIIIIIIIIIII!11I11lIfi111111i1Ill.ilflllllllllillll(IEIIIilIIII}IIf1111fillillllllllilllll <br /> ! >II I <br /> I L _n� ovsD Appum WITH CMMITIOR(2) a�enPr ,s <br /> A i w <br /> IN I�ATT KITH OGNDITIOS9) <br /> I PLW RLIYISpIRRG F.() <br /> + - 111111 V IiI;II(illiliflllll(Ili (;;Ii!III ( IIIIIIIIIIiillllillllfll1Mn <br /> IIIIIII I IIiIlI11►1i1111illllllllllli111111lI11111IlIlil <br /> I <br /> 1 <br /> I A1'rracwrr it at*aAta ALL W= zN ACCORWOM WI79 SANtpCTIIt=NTx onDlNs, erumm , aNa=a$amc> x7OW5 OF <br /> SUI'?CAC =COUNTY, 70TIVIIbPNPT MAL ttl4i n:DEPAR7F7ENT. MW OR LICEM D AtitBlPl IS SIGNATURE C Xn&a = BOLLOsvIgo; "S ckPn'Si•r ( I TIptT LIP TM3 <br /> PSRPORM ma OF=WORK FCR WMCH rr.,'is 11CWT SS I5sveb. i mesa NOT manm AW Mi W IN S=A HAMM AR TD I <br /> I <br /> ucon MBJ=Tb wom=,6 GC511lSN==06 LANs Ojq 09M70mA.,, tbXVft&ttR,S 131M (: ca <br /> ffMmM%A==szosMTalle=xxrIEs TM I <br /> MLLbWINO: "I OM=n TNAT IN TRIC PRFORWX7 OP THE MRX FOR WHICH TIIS9 PLAIT SS lot=, 1 .Qtrul SNPLOY pEaSONS auwe T To ( I 1rOlil�ii'B <br /> CCMPW TION LAMS 4F OLIVOILVIA.” <br /> I I <br /> APPLIc7►I*713 sLe&A70*7E: TITLE C 0 ALM"I-Ort- 6 0-S j <br /> +- --------------------------------- -------------- -----------------^.-------------- <br /> BILLING INFORMATION: <br /> Indicate the responsible party to be billed far additional EHD staff time expended beyond permit payment <br /> coverage per tank.. If the party designated below is different than ate permit applicant, e.g, property owner, <br /> the parr must acknowledge this responsibility for the billing by signature and date below. <br /> W P. S oX <br /> Namet.2rfi �..;�` ------Address t.J_ S ,wro <br /> C 6�J Phone' <br /> # <br /> . 1 <br /> EA 39#7d 800'id Hi3I3 £EbE64b60Z 0 C:80 £00Z14�/Z0 <br />