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TRANSMISSION VERIFICATION REPORT <br /> TIME 12/15/2615 11: 26 <br /> NAME SJC EHD UNIT 3 <br /> FAX 2694683433 <br /> SER. # EROM7F534354 <br /> DATE,TIME 12/15 11:19 <br /> FAX NO. /NAME 915594441735 <br /> DURATION 66: 61: 66 <br /> PAGES) 62 <br /> RESULT OK <br /> MODE STANDARD <br /> ECM <br /> ENVIRONMENTAL HEALTH DEPARTMENT .. , - ; <br /> SAN JOAQUIN COUNTY <br /> 1868 E. Hazelton Ave., Stockton, California 95205 OCT 2 8 2015 <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 M.. .:. <br /> APPLICATION FOR UNDERGROUND STORAGE TANK <br /> RETROFIT OR PIPING REPAIR PERMIT <br /> THIS PERMIT EXPIRE:18o DAYS FROM THE,APPROVAL PATE. INDICATE PERMIT TYPE BELOW: <br /> D TANK.RETROFIT O PIPING REPAIRIRETROFIT 0 UDC REPAIR/RETROFIT D COLD START/EVR UPGRADE <br /> F EPA Site# Project Contact&Telephone# <br /> G Facility Name AL1 i:5 e t2-S Phone# �c�� � ; 2 7GO _ <br /> i <br /> Address W . 1-6 ra P /i� CK. <br /> I Cross Street <br /> l Y Owner/Operator Phone# Coq 77— 6000 <br /> 0 <br /> Contractor Name �i C— Phone# <br /> N Contractor Address � CA Llc#"'y �� Class r�� <br /> T <br /> R Insurer work Comp# <br /> A <br /> c ICC Technician's Name Expiration Date <br /> T 6c 1-K�G►J -DS [� <br /> o Expiration Date <br /> R ICC Installer's Name g A�Ti <br /> Date UST <br /> Tank system work area. Tank Size Chemicals Stored Currently Installed <br /> (i..e.87 VVpVnq Eump,41 ieaK aeteator,UDC'i 12,etc i <br /> T <br /> A <br /> N t <br /> K <br /> P ❑ Approved ❑ Approved with conditions ❑ Disapproved <br /> L (See Attachment With Conditions) <br /> A <br /> i N Plan Reviewers Name Date . <br /> i <br />