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09/09/2003 08:26 120936543 TANKNOLOGY PAGE 03/05 <br /> 09/99/2003 08:50 2094683w'. FIFTH FLOOR of PAGE 03 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E WEBER AVE.a FLOOR <br /> STCgKTON,CA 95202 <br /> APPLICATION FOR UNDERGROUND TANK RETROFIT.OR PIPING REPAIR PERMIT <br /> TMIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. DO NOT WRITE IN ANY SHADED AREAS-INDICATF PERMIT TYPE ORLOW: <br /> TANK RETROFIT _PIPING REPAIR/REiPiOFIT ,UNDER DIOPENSCR CONTAINMENT REPAIPOW-YROPM <br /> . --------- <br /> II >aA 9172 0 1 t CQarrArx &TI ms ! ...... .. ...... . .. ...................f <br /> jF I V=Lrrr]m a �2dzy, ,�............ ...........• .._.._........ I v. # ?pQ.:S:�g �.�.. ---I <br /> jz -��s_..... $��?.. t� --- �44f]..........• .....................................r-- ........................ <br /> I i f moss ST4mIn • I <br /> I Y <br /> ---------------­­- ..................................... ----------- .............................. .................... <br /> T <br /> .I <br /> ( I olao>nI/Isllazall I v # <br /> Ia ,--------------------- - •--- ---.. -........_...._.....---- ------------- - <br /> s { a> Afll1RESS K. `".=4-C - /�+C7. 1 `mss ._. .... I <br /> R mom= <br /> N I......... i 0.1?�_�p/STr�,.^.7F.�4.:.a�..�.cC................•--.........Y_�YWoax."_------ F •j <br /> I C I In= Zig' ftTf= 1 <br /> 17+--------------------------------------------- ........................................................_...................... <br /> I <br /> 10 1 { PNOM Ir 1 <br /> R....................­---------------------..........................---------------+----------------------- <br /> ---------------------- ............................ <br /> --------------- ._.----------------------"."..."...........----•-.._............._.... ....................... <br /> I I 7Rm1K IA# { zl=SIZE I CUW1xCass 8'==Ct MMT/FAmmsLY ! O v6T IKlTCRLLBb <br /> ITI $0- f i <br /> I A 1SR- <br /> N 39. <br /> 4-NIa9. <br /> Iclas" - <br /> { <br /> * - Illllll{Illfll11111111111 R1till 1111111111111ZAPPRMW <br /> Illlflllli11111!IIiI111ll�llllilllilliltil{IIIIIIIIIIIl11111111111{!111111111 <br /> 1 L I Al rn� HIT=carni I nzmuea +lsn 1 <br /> A I 9RSIm ITi1 i I <br /> I x 1 urs IQYIBIPR $IPAr+� ��I I�Ite <br /> �---111111111111111111111111111!lIIIII111f 11111111I111Illil ill! 1 lliffllllllllllll III IIIIII111il111111111i <br /> 1 AF9Li=Maur rcum ALT,"Mm Ito AC6 M MGC W=am JOAQC==am= 11 ITS LMIS, ALA WIXPA AM AIDRJT.A71= of I <br /> I W;=a=COaM, SAL MALL74=FAR7M W. QMM 1W T.zGf�ii =)=W la sIMTMT=MIPar,=P'CII::.o1r ! "I C>Mr=EIY 1 I %TERT IlT TM <br /> IMI—MOCR OF TM W PMR WIUC$rAZ5 P13WN TS x360®. I SjMLL=MOWY ANY MM W 81=A rM WR AS W I <br /> RK09 OVA=TO WORKIM'S COMNIOMW LAM!OV CRLZFof ZIX," M:nACi 18 Iri =OR 9Ga=nKTMM SZG1 WP2 CF'RMPI"S vMI <br /> I lFOLu7wmt It CERTIFY MIAT Sffi cul;PlArofflames OF THE WMX FOR WMCR=2 !!ZWT IS IS31M6A. I mmay.E non FBft9oMs SMJE=TO <br /> c eN9AI`IOp LAWS or CALnMPjrLA.• I <br /> I I <br /> E I <br /> I I <br /> 1 au,nr2MTS <br /> 1 1 <br /> y-------------------- ".------------..----------_...,,-------- ............................ _ ......-- ..._..-------------- <br /> BILLING INFORMATION: <br /> Indicate the responsible party to be billed for additional EHQ staff time expended beyond permit payment <br /> coverage per tank. If the party designated below is different than the permit applicant, e.g. property owner, <br /> the party must acknowledge this responsibility for the billing by signature and date below. <br /> r L Phone# Zo ala 2 <br /> Name C-��� >r.s Address ?-6V- 3 -57 <br /> EyC7 rp 1 <br /> ��.�J'� .a1'�cc T���;,�a'�a, -*V7 <br />