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• Jul 23 03 09:35a Franzen Hill 5598881-46`7 p. 3 <br /> 07/23/2003 09:06 2094683433 FIFTH FLOOR PAGE 03 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> -.K+4 9 WcB=R ANIF,3"o?Dox, <br /> STOCKTOM,CA9=2 <br /> APPLICATION FOR UrZEROROUND TANK RETROFIT,OR PIPING RSPAIRPERMIT <br /> THIS PERMIT EXPIRES So❑APS FROM .4FPR:1 v'ALDATE, DO NOT WRITE 94 ANY SMACED AREAS.INDICATE:PERMMT TYPE BELO%V: <br /> TANKRETROPIT >c�ai?i�l RSPAI ErROFA UNCERDISPEENSERCONTF.INMSVTRgPA1FVRETROFIT <br /> •_•--- -- <br /> ------------ ------------------- --------- -- <br /> 1 01A$ITS N 1 PROJ8'_-I• CCUTACT 6 TBSPNCNE Y <br /> I F i-Facir-;rY ---Kwik Serve .._..... -- ------ ------... -- ----- -�-oxoare a 209-239=79y8 _.._.... 1 <br /> Z .-AGGRESS--4�9--�S.--Main_,St.f+Manteca------------------------------------------------------_-•--- ...----.,..i <br /> 1 L ..... <br /> E GREET -. ._...__,..-------------------------------------•------------ ---------------- <br /> I -------------------------------..._____..._....._.__.__......__.._........_-.____._..._ ___" ________ .._...___- I <br /> OWLZB'RiCA$R4Z08 I PHODTC Y <br /> i I - Boyett Petroleum I 209-577-6000 f <br /> CONTR=,ORNF}iE- Franen_-Hiii Corporation�__�--- ----------!-reoe�K_55�=�8:8�2:97T". ------ <br /> o ,------ <br /> -..----------------------- - -- --. -. <br /> 1 N I CONTRA:'q[1 kL' --ss 1100 NortfT J St. I-:R LIC-* I-=ABS <br /> C { OTHE'R ]-1FORKATION I'llt- � <br /> �} -------- <br /> ------------------------------------------------ --------------------------- -----------------.­------------------- <br /> R -------------" --- <br /> Rlilltltll^iliillllllllil ------------------------------------------------------- -- - --- -----I Mn �---- -----------....- _. <br /> I TAM ED M T ,< S ZE ' ° CtttRlr�s.t i.0' .^CS.R=LYL2SEVM8LY-I 7ATL 'UST INSTALLED ' <br /> um <br /> T 39- f . 0�0 .a n_si I— - <br /> A 1 af- <br /> 1 <br /> 31- i- -•� —� --— <br /> -� 1111 I l II i Ii ilil IRT , <br /> iil;'1 :il il_f11111 <br /> I I illlltl ill it �„ i;lltl ...,, <br /> L j VR vro ATTAQRCO I WN H C=%wm slxnaano= %� O 1 <br /> A U AT'„hCHdGFSiIi'I WITH C.gNb IT ioNs! ,t...•IpA.,'(/I-,I <br /> IY i DLA."i :=SVI EYfSitS AAM � ' <br /> ►•• 1,l"Illli l!'itll'!±; ,1111 11-1 it1 :7'7 MTF M_Tl III I11 ;1 MT:II ,111111, , I ,:I ± liir <br /> 1 1"LICW. MUST ?MWcjRX ALL WokK Ila AC'WWkNCL- TITS SM JO r + c <br /> JL, COUNTY O?AIVANCU, Smrs L;LWr. AM mmrs A\T R=ULAT:ONS O- <br /> 1 <br /> SAN 4cAQUIN COUNTY, &NV:PA\V.M.r,%L RB:.LT4 0ZVAR"_TMC - MI SR OR LICT"En LCWvS sIGmArm£ Cs=:r:E8 TV-4 �LLO'�•:NQ; ^.ARTIFT. I <br /> MIT Ili TUB PERI ORMDYCZ TF'THE ;rRK FOR '.I7= 'NIS P"KIT L9 ISSLUSL, I SKAIL NOT V4?T IY ANY RMU0.1 IN SVCt A MXWER'AS n i <br /> I 8EC7MZ SIMMC' TO WOAI!kM'S C:lL 2NEA:tAS_i,ii 1-E Di ^,'•�nsf:R-" COV'r*-U.TO&'D HIRING OR SL'YCONTM=ING SIMM=RE CERTIFIES SHE <br /> FOLLONIM3> .I CTRTIPY r'iAT Its'.ffiTNI; FERMr, IS IS 1=1 I SI'.ALL EN?I01? PERSONS Trig EtT TO 4 <br /> NORNYR 9 �'rFt=raArssr+ L,ae��- • - .-, <br /> E I <br /> ' AaaLlcxb-r•a slcuRnms. Service Tech _ 7/23/03 j <br /> I { <br /> BILLING INFORMATION, <br /> Indicate the .responsib;e 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 responslUlity for the billing by signature.and date be)ow. <br /> Name -- _---Address Phone# <br /> Signature--- -- — -- <br /> l=H230038 <br /> (rsvised "I/3,1lo2) <br />