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PUBLIO HEALTH SERVICES <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION Q .x <br /> Ernest M. Fujimoto, M. D., M.P.H., Acting Health Officer <br /> 344 East Weber Avenue, Third Floor • Stockton, CA 95202 <br /> 2091468-3420 <br /> PERMIT APPLICATION <br /> TO INTERIOR LINE/REPAIR UNDERGROUND STORAGE TANKS <br /> NOTE: ONLY UNDERGROUND STORAGE TANKS CONTAINING MOTOR VEHICLE FUEL MAY BE REPAIRED BY THE <br /> INTERIOR LINING PROCESS. IN ACCORDANCE WITH SECTION 25296 OF THE CALIFORNIA HEALTH AND SAFETY CCOE. <br /> SUCH AN UNDERGROUND STORAGE TANK MAY ONLY BE REPAIRED ONCE. <br /> Facility Name: <br /> Facility Address: . 5 C �� ' ,- <br /> City: 570 V State: CA Zip Code: <br /> Contractor Name: T . n. <br /> Contractor Address (mailing}: <br /> City: Lc, - State:-CA -Zip Code: 26-eq,? <br /> Lining Contractor: f <br /> Lining Contractor Address: <br /> City: State: Zip Code: <br /> a Approved c Disapproved <br /> Approved with the following conditions: �- <br /> &d -4 /9 _' l <br /> fi / <br /> C <br /> DateR.E.H.S. � <br /> r - <br /> A Division L)r fan JoacUM CJ LItV Eieal:h �ar�fir:ices <br />