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0 <br /> NOV 21 2000 3:25PM HP LRSER3ET 3200 p.2 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304E% AVE,3"0 F?DR <br /> ST <br /> =14 cA 510 <br /> APKICATION FOR UNDERCMOLM Tient(RETROFIT,OR proMK,REPAIR PERMIT <br /> THIS PERIXTEX ME$AD DAYS FROM TMEAPPROVAL DAM 00 NOT MME IN AW SHADED AREAS,INOIr PFJtlyIy.TYPE 80.0W: <br /> YANK RETROFIT PIPIN MP ROFF DISPOIM CMUNMENT REPAIiIR <br /> a_-----PA - -- 9 - _--. ---__-- ------„-------- ------T [ •--------------------- __„-_„f�ETjAO�F1IT��/[j----------------------- <br /> _--i <br /> phoze- <br /> CCMC <br /> i A i PACELIIY NAIgOIj -___-� T --------------------7-----F _- saw <br /> ---_-- -Y� /^--�_ S�J�-•-: <br /> j -ADD--BS- -1--— - !_LJ4 ..-----__•_--.._—..„—__ A-------J®'-- _--_- -; <br /> i--- 3t1..___ - _ <br /> C i CoxzaACToa-'""pct' rl_i ? Slls �'LA----------- ---- - - - ---•-e- s �_`U ------ <br /> TCONSWiC. N :CJ.-L2G-„_ - ' ,_piR -. -„�• <br /> _. ,... Pa�AxLR�flF 12 x1Ar�1Z.----- --- - ----:x .conP« _ _�` L- ----- <br /> 0 i--------------—---------------- <br /> --------------------------------------------------°'---------------- <br /> ---------------_"-- <br /> R ------------------------------------------------------------------'------------•----+FNOR,-/- ---------„_ - '-f <br /> :Toni io ®I......,.. ------------------------ - - - Pam r--- -------------------- <br /> ��O COAfF9VTLv/PA@VSoosEv OATS BST YWSTALLSO - <br /> T 39- I <br /> I A 39- <br /> E I 39• j <br /> i R 1 39- <br /> 179- <br /> 39- <br /> + Z-1.1 <br /> 1:N .,Fr ..rr... <br /> I' WzrM CMITION($4 DISAPPROVEDrPLAR RWINNENS Nava .� T WITH COMor om9l ` Ol/D� <br /> ......r....,...:ii rr..rrfll:r.:ili.... ilii.... ..... nArt <br /> APPLI <br /> .... A.. .. i ..... r. . .. ... .. •�ifillti .ill .r.ii:.�.,.. .. iii. �:!!:... fl:.r.il;i <br /> SAX <br /> XJOAQU,NST PERFORM ALL MRK IN ACCOW W A WISH SRN SORMIN CQ=TY ORDrNA*=. BTATa LAMS, AND Rola,AtoaIwA;UTATIovs or <br /> I . <br /> JQAQUlp CAtE7TY, REµ OCPARR8- ER OR LIMBED AGNT'B SIGNATURE CK72rXEB Tag POLLOMINO, •Z CaR7'IYY ` <br /> i 7 11' IN 170 P✓3alP N oP TRS NONR P� Ca TKIS PU IIT 18 ISSUED, S BRALL XOT Ii W&OY ANY PgE o IN SUCK A KOM AS TO <br /> S <br /> to NCBYaE'g CALIP=IA.• OOBTRAC$OR'S 111REW OR NSM--MC71M UMATUag C'UT]PEEE T7IE <br /> POLid74EM$: •2 CMTZPY AT ZR O RX MR MRICH TRIS PUNIT IS ISSUM, I SMLL g"Mi-PERSON, SBB.7E4,'t TO <br /> i MOEIRR•S.CORPEM=ZON oP <br /> I <br /> y APPI--- --------SIO------r-.------.___-----...---------------•--_-___-_-_- _- »_„._-__� -- <br /> T217.6 'la <br /> --- <br /> ------------------------- <br /> BILLING INFORMATION: <br /> Indicate the responsible party to be billed for additional EMD staff time expended and <br /> coverage per tank. If the bey permit payment <br /> owner. the parry must acknowledge thisnn:sponsibr Iry Is different <br /> billing by signatu e1 and date beloucant w,property <br /> Name ti- Address / r t [� ., - Phone#moi 'f- <br /> Signatu ° <br /> EH230038 <br /> (revised 1/31/02) <br /> i 'd b i tbLLE660Z '4aa i A U04 40045 JO R4 Z 0 eS0 :80 so 82 AOW <br />