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/2005 15:26 2044633 FIFTH FLOUR • PAGE 04 <br /> SAN JOA QUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> a04 E WEBER AVE•9°p FLOOR <br /> STOCKTON.CA 9-202 , <br /> APPUCATICN FOR UNDERGROUND TANK RETROFIT,OR PIPING REPAIR PERNiT <br /> THM PERMIT E.1p1RES 90 DAYS FROM THE APPROVAL DATE. OD NOT V4RITE IN ANY SHADED AREAS.INDICATE PERMIT TYPE BELOW: <br /> ✓/TANKRETROFI^ PIPINGREPAIRtR TROFR`UNOERDISPENSERDQYTAINMENTREPAI.*JWROFIT <br /> I I SPA ELT- E .... cmr=_ a T-------9 <br /> ... <br /> : P : PACxrt NAHc ` -. ✓ �j? 5I MONE a - <br /> : psi? o <br /> 1 L CHYUGS STE6GT __._.. : <br /> 1 I .____._______._f �~.+et'Y t______________________ ______ <br /> ' T : ONHEAlO1MiRATOR •••-•--• •• <br /> NaNE a <br /> Y <br /> P <br /> ,.......... ......... ... ........ — _— _ --w___-_-____---_-___,--------______.____ _ <br /> c : c7RTR�mR N:Nc 5(CcY�n CrsWQifW ----- t <br /> : N ------'---- - ----_'n0_tY_�_I L_V n�.Yp,-'-`�9�ry��.ea Lxc a_.Q1��Y_�_-___;. cLha3 A ��dy'_. <br /> q ____________Po'________ r.. i!� L_v_ 11 LP R <br /> INSUWeR 11 QAf ________—_______________ I iVOAE.NRP.a�.11a•87 ' <br /> I A .-�........Y! �•C Z — <br /> 0 <br /> 7 R ._—------------—----------------------------- : ----- P <br /> +'-_.••:I:1;11::!I'I:IIi i'11:111 _ -_ .----_--_--__ _______ _ ______ _ ________ ______ <br /> ... _ PiOHFP tl 1 <br /> _ ___... _ .____ .. _ <br /> 88 T%aE ID ♦ !O _ Raft SIZE CH=C" SMASC '_'VPRCNTLY/P SVIODSLY :•OATS :WT INCAV.� <br /> 0. 18• r H I <br /> 1 a � x9• <br /> K i 39- <br /> I S9• _ <br /> ;;. •. .;I..::II f:1.:t..::1.11 I:I11—{I T,"."—rT,1'.�T-'j;:';^ <br /> �/ APPROVED PITH MAUITION(S7 k DIBAI'P 20 <br /> A - 1386 ATTACWW- WITH CONDZrx0a8) <br /> p i PLx.`;R^VInaERB NABS <br /> DATE oS <br /> NPPLTCAN•L• NOET FERPOt�I>,xyl MURx m ACC9RDADCS •IT14 SAN JOADT_N COUNTY ORDINANCES. STAB 1AWa• PDD rmw APD Riv=r_Ca3e OF ' <br /> SAN JOAQUIN COURn. ENVT_ROAlffVTAL BEAU:i? sx. OMER OR LICENSE) AUERD'6 S_OtmrUt3 .SST1PI59 THE nI,11)NILO: C3P.TIb-t <br /> SEAT :E T,6 '+SRtDRIVWiTe OP 1'aC HfAfK FOR b'I:ICH THIS PIL44I7 IF ISSUED. I SNAIL ?CT HESLDT ANY PaRSW is EL•DR A H km AS TO <br /> BEZC143 SUWECT TO HOIt M-9 OOMPI! . VxDM xw Or CALIroNNIA.• ODv-AACTC*'S 82=A0 64 Et=NTAACTIND 8IQATA A% CERTLFiE9 :T.a <br /> MLLDMSN*! •I CPE4xPY THAT IN THE P"FORMA= OP THS '.VGE FOR NRICF. T41S VERN= SS ISSUED. x STALL EMPLOY P=ONS SOECECT To <br /> NORIM-6 CONPSNEATZDN IANF DP CALIMPAIA : <br /> APPLICINT'S 1:1=TOAE: ['��j'j��/7i / T:TLE Q ../ DATE ; <br /> BILUNG INFORMATION: <br /> Indicate the responsible party to be billed for additional EHD staff time expended beyond permit payment <br /> coverage per tank. If the party designated below is different than the permit appCcant, e.g. property <br /> owner, the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name 5��A�ddr�ess ?&"Fe AC 7!�70NtPct l�sa�t6 Phone#0fYZ:!r -3;?- <br /> Signature <br /> 3;;Signature <br /> EH230038 <br /> (revised 1/31102) <br /> 1 <br />