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May 15 03 05: 05p TFC RCCUTITE 65n 952-7631 p. 3 <br /> ... •.s <br /> 05/13/'2£03 13'29 20949$3433 FIFTH FLOOR PAraE 03 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 704 E WFFIFR AVE,3"a FLOOR <br /> STOCKTON CA 05262 <br /> APPLICATION FOR UNDERGROUND TANK RGTROI=tT.OR PIPING REPA+R oER411T <br /> THIS PCWT EXPIRES 9O DAYS FROM THE APPROVAL BATE DO N07 WA)TE;N ANY SMAADE®AREAS INOIGATE PERMIT TYPE 09LOW <br /> TANK RF.TgC,-IT ___PIPING RtPAlWItEYROPIT xUWkm 1,w SPENSER CONTAINMENT REAAIRf.RETROFtT <br /> -------------------------•- ......._.... - .----- g <br /> ..__...-_..--._...G L C3OU2h42�''9� ?Rp.MCT CnwrkC2 IrsL' ttt> h k�phi t,�LE�ii {£?E ----------_- <br /> • ..- rHoxa ------- <br /> ---------------- <br /> - 21! <br /> J I"cn TF <br /> F I F.3CILITY JIAW; ..........---------- <br /> -------------------------------- <br /> .......-• i <br /> _...-_- ___-__-_.__..............................__.___...,. <br /> i C AO17Aen 102.2 RzoN dA69 POA I�f'� _________ __________________________ <br /> 14 I [Rose ffruxY I <br /> s i i0 {3t 1''1 'i o1L ,1V 1,_ ��. -i <br /> 7 '-- ....------•...- - -� rNr .d.G i_DN.�IEGP"W`R {v50.qvg- ............ <br /> C. ccn y■Anaa Im�►+e"( t�1Dl1�AV, -- <br /> .._ - - I CLX:;s A 14AZ 5 0:16 ` <br /> I,.... �,LIC 7b20�'4 <br /> .v 1 cari uck—ss 55 50VTO UN05N AYENIJE ..... ................ - i <br /> .......................--•- - '------------- 1691(wgg -D2 I <br /> K I INSUIiSR FrA-''1� VUN�' --------------• - i <br /> C I ---------gRM1' --- --------.-_.-_•• ......_•_ - -- _ ... ..............a.•"._.---.._».. ..-._.-._---- -----I <br /> . .. <br /> 1 Pt94 0 &� 9�2. �Tr7r I <br /> { r� v N 1'r + -_._._... ..-----. ` ---- <br /> 14 - ... <br /> I ----------- <br /> i <br /> -- <br /> I 111111 i l!I 11111 11:`,.161 'v 111111 <br /> TASK size r I ,IcrLs sro"^ rzr/caRvzalux r I n■� T=`�I" R° <br /> - ! <br /> I ! ss• r �i � � I <br /> T !, JP• 1 I <br /> IKIyr. <br /> i I <br /> 1111111;111i1111,11i"It1':+'IE11;111 1'11', i'�511111liliilll"IEIIl:11111illlllf 14111'IIilPlli'I€I111,11 f11111Vi1'Illllllillllilifl <br /> i � i ,�®7sa7[xcvsa I <br /> I t �.�' �A4PA0�etT!° t�N9ISICRI157 � I <br /> TI1Ct�F1'wlTw�nxnwlsl 13 Q" <br /> Ac I DATE <br /> F'..W KWIKN".AS%W.414 <br /> 11!1111 <br /> SISI :lll;;tlllllli111111lll1111II;IIi <br /> �'.;II`II'iil W!111'tl1 11111111'1111,111111111 ;1411.111k1111113 7- III,lIIIIIIII111'e l <br /> 1 ■i Ix StiN.[S7ru7J7a+CaaxrrY CP.LSAIAFC[1t, e'_.1TE LAWS, AW ROLL AND jttwuTx6K4 Of I TwtiT IN 7xe <br /> a•+PE.IC,WI KrT pwokN ALL WORX IN kCCOw"C' R I.�CQK52D aeRrr�sr LSL^.U.TSAIt C€RTIFI£s Tw6 FDLLOUI►SLi� 'I CmTlry ( i <br /> :aH lt'AIpItIx C'OLR•"TY.. ENVIR `TAL.tIF,FtIU T 1`9%NYlf[' OMiC - <br /> +ciFO'.Y (ZF or TME MORK rCA to"Cw 'CUSS E°f WLA L. F C%u I SHALL UI]I•r,.ACMRtDy 6 "tgIj*N fll CqN A CT:M .SS TO I <br /> BCC�+I{' :*'JL.7EC7 TO WMUCLK-S OWE CATICOC 1.7�w6 OF W.t[DEYxA." C6VIIhAL'IOA'fi IAZT f CR -lim rrRlima 7YLTy PFL. ONS Sus TW FFJttKLA <br /> 1 KI9LIJMIIiG: i CST-[Y THRT ZN THE VvvvuWs`XCB or TN&UOK] FOR"HIC"TillH SAMIf YS IS!lriD. 4 rima EIA9LOY PF xSORS SVS IFCT TO ! 1 <br /> 1::*FW'AT3CN llros J" CALTrOWTA.- <br /> 'I TT_YLI; _ DATE 11. <br /> 1 a[[;.IGASII'a sIGNA -- I <br /> --------------------------------------- <br /> BILLING INFORMATION' <br /> IndiCate the responsible party to be gilled for additional EH© staff time expended beyond permit payment <br /> roe owner, <br /> coverage �. taint�rnowledge <br /> If the parry designated heiowr is different than the permit applicant. e.g. D p rty <br /> tt party,fn st.,� this responsibility for th billing by sig[ t re and date below. <br /> ,.r c t _ f �' S u f'J-- rr <br /> r Address 3 �. - < <..._ _Rhon,b i� <br /> Name- <br /> r' <br />