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WorleOrder: 2255433 • <br /> ENVIRON ENTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> 60 East Main Street,Stockton,Califnraia 95202 <br /> 'f lephooe:(209)468-3420 Fax;(2(19)965-3433 <br /> APPLICATION FOR UNDE GROUND STORAGE TANK RETROFIT OR PIPING REPAIR I'ERMIT <br /> THrS PERU IT PI REB W DAYS FROM THE APPROVAL DATE INDICAra PERWITMEeELO'i f: <br /> _ 1ITFNK Nnrnoo Ir I ?IPINGREP.LRRErROFIT LOCREPAIR•RE-ROR <br /> F EPA Site 9N Project Co..9facl B TelephoneY <br /> --. <br /> C . FaOfly Name J.'QCO �[� p.. ... __ _._ <br /> aCAricirattA C - <br /> Owner;Operator p/kT<o _ Pnace.r <br /> Contractor Name 7 'VN <br /> ConlraCa Address 677 E 1pr.KF o _ Phone 4 <br /> CPhone 4 <br /> A Lrc C_ Claae <br /> N _ <br /> A Inw:eTJ�- �i WGrk Com g3�i� <br /> P LF <br /> ICC TEGgnx:ian's Cenilicatio Nur ber�Oe'•c1 ti's Expiroicn Dare <br /> F. - _ <br /> :.o ICC Installcri CertlOCaliOn Numb EKprtetion Dale <br /> r......._. .. I <br /> --.... .y . . . d ...-._. <br /> j Teck ID k tank 5¢e CBemlcals stored <br /> -. .—_ _ Cunenli/Prevlauel Dale U:' <br /> T <br /> N <br /> . Apprcvep [Approved-M condlbone -- I �D-saoprowd <br /> ,A (50e AdAchmant With Corotiti,i <br /> N 1 Plan Revlewels Name Dele <br /> -APRGV,T UVST PERFORN ALL WORK N AV RDANJCEWt.HSAN:O.AOUIN COLATY ORDINANCES.STATE LAWS.ArvDRO_ES nVJ iE[. <br /> J0 DL'PI-CUA!-,ENWROAMEWAL KFALTN EPARTMENT.C•muER OR-ICENSED.AGEWS SIONAIVRE CERTIRES T.He U-M A..,3 <br /> 71a PERFORMANCE OE THE'NORK FOR iii VMS PERMIT IS ISSUED,15NPL.NOT EMPLOY ANY PERSON IN 9UCF.A WIIaNER AS TO SEC' <br /> 'AT;RI<ERS COUPErvSATION LA'' 5 Or CALIFO NIA' CONT' ,TORS HIRING OR GLSDONTPaCTING sID.VATI,RE CERTFIES T4 Fi:I 10. <br /> CA.'Whi;RFORIA 'CE OF TMe-MWF K4CM TFIEA <br /> , M:TIS SWED <br /> 1 . HALL IlYnO•I PERSOI.S SVBkC' IC y,'.:RSR <br /> TA:IF,,e1 <br /> -C - I S5C(Wd <br /> Aprk:wx YE aI.s T. TiCe <br /> BILLING I f2MATION: <br /> !-dlcane he resporslbie party to be blue !o,additional EHD alaS lice expanded <br /> Me Darty designated below is d,feren then Me . ed beyo^tl PermitDaynlerlt coverage per', - <br /> nesFUTsibllty for the billing by s.-gnihrrea date bplowmmt aDFlicant, e.g. property oomer, the pally mvSt acknoMe. <br /> TITLE <br /> _ .. .... PHONci_ <br /> ADDRESS ,_ <br /> G•aI2p S(M—aca 813/7) <br /> 1 <br /> Tanknology Inc. 8501 N.MoPac Expressway,Suite 400,Austin,Texas 78759 <br />