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PUBLIC HEALTH SERVICES <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DIVISION <br />Karen Furst, M.D., M.P.H., Health Officer <br />304 East Weber Avenue, Third Floor • Stockton, Gk 95202 <br />209/468-3420 <br />PERMIT APPLICATION <br />TO INTERIOR LINE/REPAIR UNDERGROUND STORAGE TANKS <br />rgUl�y <br />NOTE: ONLY UNDERGROUND STORAGE TANKS CONTAINING MOTOR VEHICLE FUEL MAY BE REPAIRED BY THE <br />INTERIOR LINING PROCESS. !N ACCORDANCE WITH SECTION 25296 OF THE CALIFORNIA HEALTH AND SAFETY CODE, SUCH AN <br />UNDERGROUND STORAGE TANK MAY ONLY BE REPAIRED ONCE. <br />Site EPA # O O(�� <br />Tank ID# <br />Facility Name: <br />t'T - N - Go <br />Facility <br />Address: �7V <br />w, /• he /2dt ,a <br />State -Zip Coder <br />City: bra �y <br />Contractor Name:—I) <br />Contractor Address (mailing): 7, u <br />State: Zip Code: <br />City: <br />Lining Contractor: <br />Contractor Address: <br />State: Zip Code: <br />Lining <br />City: <br />I <br />Approved C�^��c.�r� ❑ <br />I X/Approved wp the foilowin condi ions: <br />I � 2 X y ; <br />Disapproved <br />I <br />m <br />I <br />i <br />I <br />I <br />Date (� /S� <br />R. E. <br />I <br />I <br />I I <br />A Division of San Joaquin County Hcalth Cue Jcrvices <br />