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'PUBLIC HEAM ri S RVICES <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Karen Furst, M.D., M.P.H., Health Officer <br /> 304 East Weber Avenue, Third Floor• Stockton, CA 95202 <br /> 209/468-3420 <br /> PERMIT APPLICATION <br /> TO INTERIOR LINEIREPAIR UNDERGROUND STORAGE TANKS <br /> NOTE: ONLY UNDERGROUND S T ORAGE TANKS CONTAINING MOTOR VEHICLE FUEL MAY BE REPAIRED BY THE <br /> INTERIOR LINING PROCESS. IN ACCORDANCE WITH SECTION 25296 OF THE CALIFORNIA HEALTH AND SAFETY CODE, SUCH AN <br /> UNDERGROUND STORAGE TANK MAY ONLY BE REPAIRED ONCE. <br /> Site EPA # <br /> Tank ID # <br /> Facility Name: 4k33 �cto�s `�2�W: �A6kk l� Facility <br /> Address: City: <br /> S�ac\c A;-<-e State:Gh Zip Code: t0-1- <br /> Contractor Name: S C <br /> Contractor Address (mailing): VT City: <br /> State:G:+ Zip Code: LA4sl+ <br /> � Contractor: Lining ' <br /> I Contractor Address: City: i <br /> State:VPnv Zip Coders bG <br /> Q Approved G Disapproved <br /> l/Ap roved with the following conditions: c f <br /> t W C',K 4,Y1� <br /> Date R.E.H.S. cam. <br /> i <br /> FEE 10 '999 <br /> r,r; <br /> N lvli H1u3 <br /> `%y V <br /> A Division of San Joaquin Counry Heairh Care Se:rices <br />