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.SEP -13-2004 08:29 SBC 9258730584 P'02 <br />' <br />SAN JOAQUIN CON|NTY- <br />` <br />ENVwR6NMENxAL"w»_A~.="" DEPARTMENT <br />mmI-wFm�wAVE, ORD FLOOR <br />5TOCKI)ON,uA"MZ <br />APPLICATION FOR UNDERGROUND TANK RETROFIT, onrW/*mRGpwpPERMIT <br />Tmis PERMIT EXPIRES 00 DAYS FROM,TKE APPROVAL DATE. 00 NOT WRITE IN ANY SHADED ARW./NDICATE PERMIT TYPE IIIII-Oft . <br />__TANmAMOFIT' IP/wmREPAJPJRETR0FIT )eURDERomPENSER CON-rAINMENT REPAIFURETROFIT <br />---------------------------------------------------------- -........ '--------------- ............. __-'----------- ---------- <br />, EPA <br />____ -;EPA =%vw |roWWfmWr=^,ewwmM <br />| ----------------------___-'--_----__---u-��u��� <br />��__��~m�-���-o��'�---_-_-'| <br />� <br />mm <br />�h_�_��� ' <br />/^^_-_--_'-_�=~=_~~__'_- ' _-_-__-_--__------_-__-_____--_---___- . <br />/ c | wVOWv*�� <br />-___'-=���2;�--'��-'���-�^-^���/�������'~m_'---__-~-^'��=z��z�r-____-_'---/ <br />| u | n��a��r <br />|=~� | <br />-' -'---------'---'-| <br />' | x ____________________________________________________ _ <br />(| | <br />Pion I <br />| n | <br />� <br />�� / <br />| ��� - <br />~�� -----~-'''-'- -�-�� ----------'/ <br />------------------ <br />---------------- <br />T -------------- ����� � /=An'=='w | <br />x| soma. . <br />|� A I ------------------- ----------------- .............. __'----'------__--^_--'--_----__---'---__ <br />| <br />i u (ormmmmummm° | � <br />/ r~' ------------------------------------ --'--'--'---------------- '........... ~-------- -'-'--------------/ <br />|a\ |oum* | <br />------------------------------------------------------------- _'-------------------- ----------- --------- -------------------- <br />| <br />| <br />| rmm�* ' | <br />' -i-----'------�~'--'----'--~~~'-----^�~'`---'-------- <br />- |qWukw mom | DATE USE xmnWM | � <br />' -'----7IFY TEMT M rim <br />' w=p� <br />Indicate the responsibfe party to be billed for additonal EHO staff time expended beyond permit payment <br />coVerage per tank. If the party. designated below is different than the permit applicant, e.g. property owner, <br />the party must acknowledge this responsibilitV for the billing by signature and date below. <br />