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Apr 24 03 11s11a J/eakin 825--Q03-1557 p.2 <br />s� • <br />3W E WEBER AVE, SO FLOOR <br />STOCKrON, CA = <br />APPLICATION FOR UNDERGRQVND TANK RETROFIT, OR PIPING REPAIR PERMIT <br />THIS PERMI;—'TA <br />XPIRr" DAY:; rROM THE APPROVAL DATE, DO NOT WRITC IN ANY SHADED AREAS, INgiCATr. PERMIT TYPE BELOW: <br />NK RETROFIT __—PIPING REPAIRIRETROFIT _UNDF..R QI$PEN$ER CONTAINMENT REPAIR/RrTRarIT <br />---------------------------• ------------------------- <br />I <br />- -----....I XPA st•TR u I rRomm cr=AcT a •rmwr=m • 8aV S 1 L L� 1jr-14?2 -331 1 <br />....---------------------------- .---------' ------------------i <br />I ------------e `, a r� p^�p'�� - I InK7M( x I <br />P I FACTLTTv NgMFt 4�. N i.. '" Cw_--�,i4/`,_/`_. <br />CA— ZO <br />I L I CWiv :, I-AKKT <br />7+-----------------@------------------------------------------------- ... . ........................ <br />I T I QWM0(/0LMXX X I wKxMk A I <br />-I � 1924" - O 1 <br />I ... , - -- -- PPktA 924"- f ---------------------`>---------... ... I <br />N <br />I c I coNrsrAc-rou NAnss `/1 ,� 1 l Prra x C+� _ 7 2 'v� ��� 1 <br />�111�1�AS,1� 1_. �-�-?= '---------- -- - J I <br />N (�NC197ACTt7R ATX71iN!+. n I CA T.TC! 11 L.+ 3 f •-"�I CL+Ai.^+ <br />I I <br />I R I IN-WRRIT { WORK. Um .# <br />A ,-------�.�_-�...------------------------------------- .... ---=-`�----- <br />I C I M*Hk INR'ORMATION I <br />._____-_____________ <br />d17 <br />it._____. ____________________________ .. -E _ I <br />I <br />.. ._...-_.-__________________ P)toNs-x <br />1111Illllllliitlllllll llllllll _ _ <br />I <br />TANK TIS x ( TANK SUM I LM MICAIdi "l�41•) C'UHkjWMY/PR7(YI0UT:I.Y I TSATR TT.:T TM.TALtJM 1 I .> <br />I Tti6 <br />IAI3y_ <br />N I <br />*---Illlllllllilllillllll{IliilIIIIIIlII111Illllllllllilil11111111111111{II111111illlilllll{Illlillllllll9111111161111111i1111111(I <br />1�1 I <br />( L I APPPOVM APPkDVND WLTH MWLT11N(H) IJLI{AYNICOVKU 1 <br />I A I (.^,7ik ATTACHmRNT a rfw C=*nTTCAMR:) I <br />N I PLAN kl(VII&WERS PL41♦[+ _ DATE ,- <br />+••-1111111111111111111Illllllllilllilllllllillllllllllll11111111111111111111111111IIIIII111111111111111111111111111111111111111111 <br />AWLICWr MST PMUMM ALL SRX IN ACCORVATIM NTTH rAm jownN Cowry 0NDXX NC! ' CR'ATK LAW;. AND 1Cu"P ANO 171DCR7IaATI= or I <br />I am jQ&0aW C0T1 ff, MWnMUNM IUMLTU DEpART"AT , Mmw OR T,rCIa io AvAmIR 1,1011A'PIACH 09MLY1m. 'M 100 L INC: "I QXTIrY <br />I-KRY0b MAwC% OY wm WORK YM WHLCH TWS I'K MTT ISI:i ±flKor I SIU►GL WOO f KOY ANY PM14M TNI RIi-7i A M MNR'R AN 'M I <br />H1aYANMId ti9JH,i}SCT 70 MHKKN'!i COMPM.-AMION L Vk-, OM CJWIIAORNIA." CopTRAC=-S RIRINf, OR f:T�7CON77'7�CT'.0 iTQMATUMF. CRWTTFTR. TRF. I <br />F'07TRTTN(:: IT CFMTTVV THAT IN TIM 1W&ORMANCE OF TI& WORK FOR MUCH T111.7 PERMIT IS I-" JIM, I -,tWT, TTAPT,oY MR.IA M::.1=UY.CT TO { <br />COMMWATION TAW^.. OF (NXT.TNDRNTA." I <br />I 1 <br />I / � <br />I AVNt.7 CATPI'., !:TTNATtRdN: TITWr ° " S 17ATI <br />I 1 <br />------------ _ .. .. .. _.....------------------------------------------•------------------•-----.. . .a <br />THAT IN 71.1 <br />'''. s,i5 <br />indicate the responsible party to be billed for additional EHD staff time expended beyond permit paymE <br />coverage per tank. If the party designated below is different than the permit applicant, e.g. property own <br />the party must acknowledge this responsibility for the billing by signature and date below - <br />1 -11 -4 -CIA <br />. _ .i y, f <br />zr <br />Name <br />