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FEB-23-2005 12 :02 PM CO EEN 344 2-44 P. 02 <br /> 02/72/2005 15734 2994 33 FIFTH FLOOR • PAGE 03 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ISM!'-AVER AVL D'R FLOOR <br /> YTOCKTON,OA"W2 <br /> APPLICATION FOR UNUMISMUND TANK RVTROPIT,OK P'IPINC 49RAIR PVRmR <br /> TNM PVRRVrIA M b DATi PRCM"APPROVA4 GATE- 00 NOT WRITS INANV tNMGO Mui,INOICATV PVRMIT TTq 910.OW; <br /> ...................... <br /> .P.eJ..•I....A.c.x.c.xx..T.M.A.M•_A•_•—TANK <br /> TANK RRROPR ...__P__.W...RI9.0AAA0V0lRCiTrRAOaFIlTrAC_T i VTNAAyeiWDRYVLPYNE, R COM <br /> _._AVTACIO.NI_-KRVN-JWR. OFlT <br /> ` VAA ASn t •• •• _ - _-- <br /> ----__-___- <br /> ....... ...----–---– -- -----•–•----- <br /> I .2825-l2 Z <br /> I.AOPA9 <br /> ...._.---» .- ................... <br /> coe <br /> 1I <br /> OTYVAT <br /> : . ......................----------........»-----' -----------------»_.------•• -----I <br /> T <br /> _e..I.JCT.AeO.NNA.C.VTR.ARAR./O.A.PAR.A_.P.TA.PI_.R@.... <br /> ii <br /> .. _ <br /> I.0... <br /> PRQ a <br /> _..___–_Tl+----.---- . <br /> C .. ... Film.......................... I ..... A <br /> TAo� 9 <br /> i <br /> •---1!111111IIII' IIII L I:I ,111iI -..-____—-------------------------------------------------------------------—___ <br /> I JS- ia9K [D A I SANA PSAA M®ITTAVa iFN.® CIpRYRTLT(SRS'JTRI4US pATg em'xetsryyyDD ' <br /> T 119-- <br /> II If- <br /> III <br /> !MI t1• <br /> tt- I I i <br /> • V I ifi ". .. ..' : IIITi Itl[.711, ,t11: .���,�,.��....,,,, . .�, ..�„� 7^; '^,?' I <br /> A ' _Attienn ATTAC"moRD Y[TY H II00511TO11 _�PSJA1/RDVtD <br /> A 1 STfOn! <br /> M pIJIR VAVNnnO iiA ATTI�CRntlpT OST! CDID <br /> 1 <br /> I "Abs,tMT NOWT lENJFOAY ALI WORK _M ACCDADANCV 9M W MAQUIDDO.WTY ONOANANCiS. RATV LAOM, AVO VC'Lai ANP MO TXWO W I <br /> iAN TAWTO tvafY, SAV.ROWRNTAL IRAL[M DAAAATNAPi. P OR LIMRSED AGFWt-A RIYYIITTRA C TSPSAT THIS JVLLON , •S CUTiTy <br /> TI(Rf S;[TV.9 P'A[pAKAACi Or TNS NOUS FOR NA:LR TVIF pID :A T0P , S COAAL NOT IMF=ANS PAA.a[ W 0%A NAWM AS ^Q <br /> ANJ'.>•Aa AOAOVOT TO NOAASR'O CUavROOATION LANA e. CALx}O J"'- COVTAACTOR'V VIA:NO OR aMCONTRA(TTNJ' .N.Mfi CYTxPSD3 TOM <br /> iDSb011IEN1 ` uXXTITT TART SN TNG PIMT[NINANCA OF f- IIORA FOR "i RR Woo VARM]C Sa NSOVVO, Y MALL Replay PAANGMA AtLTYCT TO 1 <br /> ' NOFISR J GGNPPA9AT[rY [ANA CT [Oecz.pARSiI • , <br /> ATN[.SCWT'A ATgp I _//�i h.-1, r" �/j! TIT_. _Y(A( j, pRry 4 YJ ./✓ <br /> y—_—......._____wx•.......................r.--.•r_.-___._.____.—_______--.__________ ______._____________-_______--. <br /> BILLING INFORMATION: <br /> Indicate the responsible party to be billed for addltlonal EWD staff time expended beyond permit payttKnt <br /> coverage per tank. If the party designated below Is different than the permit applicant, e.g. property <br /> owner, the party must acknowledge thle responsibility for the billing by signature and date below, <br /> Name OA-m 071 AddreI F Yd Pr,D: e Phone#0efJVd= 712Z <br /> Slgnpture <br /> EH230038 <br /> (revised 1/31/02) <br /> 1 <br />