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05, 10'99 09:17 FAX 425 251 8782 B.ARGHkUSEN 2002 <br />— <br />TO 14252518782 P. 01? <br />X02-18-1999 08=52PM FROM <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SE CES <br />ENVIRONMENTAL HEALTH DIVISION <br />�APPLICATiON FOR UNDER(OUND STORAGE TANK INSTALLATION PERMIT <br />! STC)RAGE TANKS IS atILT VaLIII FUR SHE CUDEAR YEAR IN ttHiCH IT HAS BEEN [SSIED. <br />1N�TAl(�TI Of ttKDER(; REal1ESTING THIS EEXTE)1SION THIRTY OATS <br />- APPIiCATIUM FCR PNS_EN4 Upom RECEIPT OF THIS LcTTFR- <br />NIT NSE £ EXTENDED. Tk UL�?O:IIEAR � G►LIROARA ONE IME, ONE YEAR TEF]CTEHSIQN NAY BE G2AfITTD <br />IoR To <br />00 NOT uaITE IN my SHADED AREAS. <br />PR0IEC:T CONTACT i TELEPHONE : <br />ter/ Kra 4ZS 2S/-loZz <br />Sir <br />z. <br />:PA SITE !a <br />� PNL�ltE z zf� j XPi 6vw -' gsllo <br />AGILITY <br />nDRESS <br />ROSS STIEET G-cNaZ S i /LC.C-% <br />7uNER.OP�JLATCiL Ryr rim/ p 774 &70 <br />{ - + PWME * 9ZS SS/- 7444 <br />�HTRactc4R "'l� L�TTI,.E� �ZYA�v i �/C <br />(0747 SiGRRA �"eT Ju�f£ CA LIC ZZ0793 SASS R✓AZ <br />MHTRACTbR AI)ORESS <br />+ � UORZ_COMP.= <br />YES, <br />, <br />W uAS�TE �RT[FIED Rll <br />FIRE DLs{TIIICTj � C/ � 1 C�' S� OC/�Tv� f <br />aaARD a EquA�.IZATtc++ -= FAX>5��0 <br />11111111 <br />S9- + <br />39- <br />39- + <br />39- <br />39- <br />39- <br />39- <br />[film <br />9- <br />3939-i9-uilm <br />Iu1tiW111111 TAW. s= <br />to 9 1 . I I- -.,- <br />ICALS To SE STURID <br />App�y0 AppROVe WITH CORDITIOK(S) __ aISAFPRavEU <br />CSEE 'ATTAC MEHT VITH CWITIGM OATS -S 7 <br />1 1 till ill 1 1 1II11 tISII17111-1110-11111Z ! <br />rllfJulT T I WRr IN ACCmwmCE WITM SAM "cKjIN c3uMTY MIKAH[ES, STATE wa, AMD RALES AFlD REi;xn IFY THAT <br />OF <br />TT PUBO HEALTH SERVICES- CRANElt CR LICE?= AGENT'S sIGKATuW CERTIFIES THE FOL.LOWING41 "I CERTIFY TKAT (N <br />RECOSE <br />E PERfORiItUlC91OF SHBIVx FOR %MICH THIS PERMIT IS 11S7iED, I SRAtL jRjkCT G OR AKT TpACPERM (N SUCH A E =RTO(ER AS TO HE <br />g�E� T>y�upR10ER'S aF CALIFORNIA.• CONTRACTOR'S NIRSTIG OR SUBLUNTRAL'I <br />)(c SIGNATURE CEi[TIFIES THE FOLL(rJING: <br />CERTtFt�;NAij IN TNVIEF <br />OF TiE uORx FOR VH.j� TRIS PER?tIT IS ISSUED, t SHALL flIPLCTY PERSCINS SU8IECT TO WORKER'S <br />!fP£NSATI N OF / <br />I1 ; r <br />'PLICANT'6 S4(�ATUR£:j <br />i I <br />ible Party to be billed for addltior�l PNS-EHD staff time expenCed beyond <br />the 8 hat, %jnjmL" — <br />icuca�.o� <br />eastyQ,ouledga this rPspcnsibility for Che addtCianal billing by III Cure and date below_ <br />< 7r ND /h/c' � 1Tf1 ,CSN % l -✓f c� . <br />ON <br />,q2Co <br />TITLE " / E��! / QATE <br />ate the'resp <br />rt. Thd par <br />,r,y Aaares3_ <br />i <br />chane Nusber <br />l <br />dtU,e � <br />3 008 (Rev 1 <br />ZS/� lvzZ <br />1994) <br />H <br />DaEc —T <br />4 <br />