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T.:..-._ <br />T i t'if J <br />'17 <br />RE a 1Gv, <br />..4 <br />& <br />FROM <br />JIM THORPE OIL, I <br />FiV N0. <br />: 209 365-1851 <br />, ay. 29 2001 11:37AM P4 <br />Unknown b contraatox <br />lz W'har to the dep*B to gt9undwatu? _� y <br />Describo the source of intoreiadoa <br />13. Are Dyers any water welts on tWS parcel or ad)aeeatpt9perdet' YES (I m3N <br />�5 cLS <br />DISTANCETOTANIRS) <br />..4 <br />& <br />ft <br />F1W16WU <br />it <br />other <br />14. w!l; the mwgs! ptnding d9sare be replaced with an abovegrowns or underground Storsae tRDXN)' TFSC I'iOW <br />15, lndlca:a the rasponslbla Darty W to billed for addltloeal MW staff dme expended beyond 3 Door zititnam perslt pa,°taent <br />per tank. If the pant designated below Is different thin the permit aDpVc&nk e.g. property owner, the pasty amst aciceowledae <br />Us responsibBlty for the billing by elgnatnre and data below. <br />Souza �„ta._ �� _ _ �' '4z. c . <br />W -- C <br />MaWng Addrem 105 B. 10th 8t , , Tracy, CA 95876 <br />FayPhoDBNDmbrr 209 M-8330 <br />Store Tide Bats <br />EH 23 C46 iRevised 05113199) Page 6 <br />