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05/27/2005 15:25 20946533 FIFTH FLOOR . PAGE 04 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304E WEBER AVE.3'R FLOOR <br /> S OCKTON,CA 96202 <br /> APPL'CATiCk FOR UNDERDROUND TANK RETROFIT,OR PIPING REPAIR PERU[- <br /> THIS PERMIT✓rRES 90 DAYS FROM THE APPROVAL OP.TE. DO NOT WRAT IN ANY SHADED AREAS-INDICATE PERMIT TYPE BELC . <br /> TANK RETROFIT PIPING REP.AWRRTROFR_UNDWR DISPENSER CONTAINMENT REP.4LiIRISTROFIT <br /> -----------.---------_----------------_________.----------------------------------Y-------------__--.---___----______---__-__--i <br /> I EPA SITE C , PEWS=CDNrACT a TQ.WPIIelm A <br /> : r��� /'` _-•-------•----- ------ SFLk _� .. . -Y <br /> 1 P 1 PACILIT•1 HANG G -_ .. . DWON! tl <br /> A ................ ; ✓ a�cCi 5 ----------------------- --3� <br /> I : : AOPRaA3 /_�0?--�j �w ty - C -------- - =�3 F� <br /> : I ---------- .. --- --------------------' <br /> I L : @OGS 5'18857 f I ft�e I <br /> 1 -------------- ___ _ _ ---------------__-_-------------------------,.-..------—---------------__..___-_-_-__------_ <br /> : OHYER/OPPRATOR I PY.YaE R •• <br /> SI <br /> 1 Y ... .._...---------------_ , <br /> __________ I <br /> N OATAA^NR A4PRa5-.(J 2�,[ •�F Q �a y�7 q���/• p <br /> T A__'_I_0_LC_�?(:-.(�(l_1"lJ�lj,7�'!a•E•k•:IL�LEL.G <br /> i a SHAva6R .^ : NDA8.03RF.W <br /> A :-.--•---..E1. _.. -------------------------------------------------.__.._.....---•--•--------- 47}g=��----- <br /> I C OI'NaR IWPCPOHASSOq <br /> IT .-------------------------------------------------------------------------- <br /> 1 D : I PROHS 9 <br /> "Cor d <br /> TAWa ID YAmt RISC CHWCALS STO98D _'UFM:71'.LY/PAVIOUSLY DAra OAT IWETA•_ <br /> as- <br /> I N � 49• <br /> 14 C <br /> N. <br /> 39- — <br /> +-} •., li., ... :::.;:I'II:.':—..11 ,.� :: UIL'L:11 III; I <br /> I L �r ?SPROYED PITH CCWDITIQitSJX _PIBAPPFOPaD <br /> a I 1966 ATTACW1= WITH COHDTTrOWa1 <br /> E 1?LAM A:Jln-NERB NHIIS • DRT6 W O <br /> ...•.. I:: .::: M! I`\.11.. .......... LII'I.:. <br /> APPLTCAWT AOeT 6ERP3?!I A WORK IN ACCOP.DI1028 ITN SAN JOADT_B CCDM ORDI.HIIHCBS. 5=11 LAPS. ADC RJLRS ARD RIOCLAT':8^- OF <br /> SAY JOACOIW cOI,TITY, EWMON1�91'AL HEALT.t-DSD Wr. cNREa w Lic6WERO A®oT•s d_O6ArvF3 CEATTF I85 THE eJLLOHiI.O: •I Ca7.TSSf <br /> THAT <br /> IW T'.6 FeRFORtMRtDi OF THENO= FCR FHtIOW THIS PIOLHIT 25 ISSUED. I SIHuL =-. RHP y AAY PEAAoW [A EEGs A r'Ar wx JWH TO <br /> 2ECC142 SUOJECT TO WOAKmt'S C"EHEArj= =w DF OALLFORAIA.• GOA-xACxOA'A AIR.-RG OR 90Hfk`.WTRAClI9Ai AIRIA:LAC C4iTLiIPa ^R3 <br /> FOLLDNIWO: +I "ITIPY THAT IHC THE PRAPOANANCB OP THE W01K FDR WAGS: T9IS F K= x3 IRADi^J. i aRALL ENFLOY PBR60WS 306JECT To <br /> WORWUS CORFRKPATIOW LAYS OAF-CAL�IIFOEHIIA / � /��L <br /> ATPLICAOT`S EI=THIRE: �fH' GY I - T'TIE/��+',��� n LcV'&�1 <br /> _ DA <br /> BILLING INFORMATION: <br /> Indicate the responsible party to be billed for additional EHD staff time expended beyond permit payment <br /> Coverage per tank. If the part' designated below is different than the permit appl;cant, e.g. property <br /> owner, the party must acknowledge this responsibility for the billing by signature and date below. <br /> Name Address�,�e,c 7rr,,5 rrxkijFo., � Phone#-OtEY f S� <br /> Signature <br /> . ���.oas OP � I+ <br /> EH230038 <br /> (revised 1/31/02) <br /> 1 <br />