Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E WEBER AY*.3A°FLOOR <br /> STOCKTON.CA 85202 <br /> APFUCATION FOR UNDERGROUND TANK RETROFIT,OR PWM REPAIR PERMIT <br /> TRIS PERMIT EXPIRES 90 DAYS FROM THE APPROVAL DATE. 00 NOT WRITE IN ANY SHAOM AREAS,INDICATE PERMIT TYPE SHOW; <br /> _TANK RE TROFR_PIPING REPAIRREIHOFIT_UNDER DISPENSER CONTAINMENT REPAIRAiETROFR <br /> EPA ---- • : PROJECT CONTA-- 6 --------- / ____.__—�_ `_—_______________ <br /> FPACILTIY NAFii L �� - OO <br /> ' most I <br /> -- <br /> A r_-----_--------- - � ( <br /> V <br /> ! I <br /> ------------------_____-.-__ _-- O <br /> --------_-___.-_—---------------------------------------------—.________-. <br /> L C8O3S STEEET <br /> Ir---------------- -—-'2'°_'Gc2La8�.\. r_„-1------------------------------------------ <br /> T OL IOPERATOI P!IOV6 * ______________ <br /> i <br /> --------------------- �� cam` - -- --� -- - 8k `+ -4 �3 <br /> mra <br /> O i_---------- RUQ-- 1 A.-,=`- � a_.--- PHmTe/ --- ----- -: <br /> n : aamt;NCTOR ADORES: I kr.S V 1�._.T L-r�-�---------.1.--------- ---- ,um - ------c l.� <br /> T ------------ --------------------------a-L k�i-'�---'-- �C�a Z--'--" '-----A- <br /> H IN3aRn <br /> �5 <br /> A _.--______._-. T_P_-T_ ,_?,' — ''.5 l ^-�N --------.__-_—°IDOR__R-`----- <br /> C <br /> OTHER IRPOdATION <br /> T ----------__--------------------------------- <br /> R r________________------------------------_-____ i RIOTS / <br /> _-I-_-----------------_ <br /> — - . T - ._ -------------- <br /> T ;1 • -___- --____-_____-_.-.. -------- HINS / <br /> _ <br /> 39 <br /> TARA 1D • T STYE C®IICAL9 BTO RO CDpRONT,Y/PREYIOOSLY I DATE DBT <br /> _ ' <br /> DVBTALARO <br /> + � V <br /> 1 A 39- I / <br /> N 39- I I eO0 _—� �T�•M ._-_— <br /> A TMD APP%N3a HITN CONDV"ODI31 ,DJSAPPAOVBD• <br /> A I ATT^C m MWroEDIT�0I51 <br /> LR : PLA% RRYIENIp6 DANS•.��YI.O.��.. — <br /> APPLICANT N1S1' PEAFOPR ALL EORR iS ACLtlR➢PNCE NITK SAS JOAOIIIK ORINTY OR ==CEB, STATE LAPS. AND ADLL9 AND ReO1ILAT[QYS CF <br /> SAN JOAOif.K CODNIY. BpTIBONNS9TAL HEALTE DEPART11T . ONRER OR LTCOISEO A ENT's BIONATORB CSRTI1`1315 TNN PDL 40NIN6: •I CEMCPY <br /> TMT IR THE PEEFOENA r OF TBQ NDRR POR wmO THIS PERMIT I9 IssIIEO. i 5NALL NOT EMPLOY AIIY 1'IDtEIOt IN SOOT A MANNLR As TC <br /> BFCOIS SVRSECT Trl pORK.RR'9 COMP@I9AT2@1 LAMS OP CALIFORKZA.' O3RZRAL'KJR'9 RIRDTO OR RL®CpYTRACTTRD SIGNATOR. C9RT!TCSS THE <br /> FOLLONI T R: •I CEKTl PY T ID TNR PERI M"CE OF TSB MC4tK POR i CR TE13 PERMIT IS ISSUED, 1 STALL <br /> ERYpP10Y PCRSOHS SIIdJECT <br /> WORK 'S CJIIPEEBATIOC LA➢18 OF CALIIOIOIA TO <br /> APPLICART'9 <br /> BILLING INFORMATION: <br /> Indicate the responsible party to be billed for additional EHD staff time expended beyond permit payment <br /> coverage per tank. If the party designated below 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 /> Names LYN I rzvLa�,t1r„ tncgddress k>Sr3� s <br /> Phone# — <br /> C-P GL7J-I 1 - <br /> Signature <br /> EH230038 <br /> (revised 1131102) <br /> 1 <br />