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YY/AY/fYYV Va.Yw vVVrvry rim ' <br /> 5AN JOAQUIN COUNTY <br /> ENVIRONMENTAL.HEALTH DEPARTMENT <br /> 391 E WIPERAVi,J"!FLPOR <br /> STOCKTOM,CA Pool <br /> "PLICATION FOR UNDEROADVNO TAW REYEOFIT.OR PIpin 9gpm PnRiArT <br /> THIS PtAART PIRED 90 DAYS FROM THEAPPRPYAL DATE. DO NOY WR]YIMAMy/NAOEb AK1 -A 1P IBCIOW: <br /> ^Y,WI(R6YROr1T._PS7NO REPAIP/RETROpIT�-✓O/NOER DISPENSER CONTE MENT RBPAINRCTROF;t <br /> ♦......_..M1.�.....- ................... <br /> 1 I.ADA SLTR 1 __ tItDJArt CONTACT ..... DMONA P -•��••�• -... .... _ <br /> I .................. .....,_._..__. _ u <br /> .. 1:r., rAClLity.MANL -_ .. __ . .._.•c I.lt •'r_ -. `�b'�<Pc , :. <br /> C ADOAPII ------ <br /> I .._... — �cw9�- <br /> L CRO3A 27RBLT •_ - ._-_ _ ' v.:CA. <br /> jTj <br /> 1 C coxtRAnCA ....-, y .`.......... <br /> ._ . ..... _ <br /> I Y 4(v PHONE F.7.'�1 T^' �.^^�11Y'��'i •' <br /> .5.�.. ..__. <br /> .�^7�yT�.�lL�!c-_ I PllaxR 1 �j ...._ ...� <br /> 1 N ' COPTLACtbR ADOAStO t.mft -A'?'./Y„y / (• d�, � <br /> A •. _.- •_ _- F..!! !s�_ C._'�.�.C5 PA.+/�:7-a... CR•LAC_N .. _f� <br /> IAF-'•�TL�s�42.�C7'11n _ _ 1 YORN.caa.Y( d� p <br /> ..............................HONE.._.-.-._ .........._..........I <br /> R H__-....-......................................... I PHONE D <br /> ............. ....... <br /> i•^I:IL•II:I I1 i:al1:I:II I111;.I:1 <br /> --------- FR—I ox— n <br /> i 1!. TANX Ab A �I AIDS, b- CNCHICALR OTOAND eVRRCNTt}/V9AVLDVRLT I bAt9 V3T-SNDYALLAb •• <br /> 1 F 1 I!• -'—i <br /> 1D• ��^; <br /> �•»VIIII:i:I : ill �,]1 II :ILIO I1gl I I :1 <br /> P 1 II II11� I . : I i •:I .;.u; 1 M.FiTnTIII! x::111 II;I: <br /> L'! AADAOYm LD PAOYAE DN]TN TONOTTTONIAI• ,� DLAexmv2b <br /> A 1 F A AT OyxlxY2TN CONDITIONS) <br /> M 1 /LAY AAYLLxhP N DATA Z.Z <br /> ---11111 l;tllll It l:;IIIII 1; ,IJ:I.I ;I; �;:;:I,�,;llll I:I '�" <br /> ADIL1CwT NUDt /DAPOAN Aµ,vORA iN AC ANQ x179 SAN nA49111 DaDNTY OAA,F NCO2, .STATE LWS, ANO RULES AND 11MULATIDD/ OP <br /> I <br /> SAX 411001110 COUNTY. AWIAONNCNTRL 1411% OAPARTNp1T. mmSA OR LTCMFZO ACLxT'S SIONATOSA CRAT]FTA! THE Po4.ON]NOi •7 Ct2t1 FY <br /> THAT LI t 1AIIDANASOO OF TNT NONX F NNJCN THIP DEEM} t1 1JDVTR, I DWLL HOT ANPLOY ANY PA%ON 11 �UCN A NWFIER AI TO <br /> 1 AROMt 3 rt! TO Y F OANAA.• mxtILCHTOAI SIGI _ i <br /> PPLLCNWAI I'A CAATI IT UT TN NR Pb NANO!DF TNA VMION TN]! 12RNAT is 262020,Nj�XHXI,t Dewy owl", No", TO I <br /> MOSAER'1 tAN1ANDITlOS OI LTROA <br /> i. APPLIAANT'R SSOxA701111 YTt4i'x'•'�—•+R'i'jrV, g i..�Yrb rp°/ <br /> • <br /> .......................... <br /> ..................�,_„�.,w,,,• 6,._._. <br /> BILLING INFORMATION; <br /> Indicate the responsible party to be 411100 for additional EMD staff time expanded beyond permit payment <br /> coverage per tank. If the party designated belgw is different than the permit applicant, e.g, property <br /> owner, the party must acknowledge this responsibility for the billing by signature and date below, <br /> Nam c�%(cam ss Phone <br /> Signature <br /> /l <br /> EH230038 <br /> (revised 1/31/02) <br /> 1 <br /> NO *d 90I08S86071 'ON X01, 'HM SSRI K0 [0003 N!d O�i�SO ?i1.I,'Q007" 7i;9Sd <br />