Laserfiche WebLink
03/07/2005 16:17 2094653433 <br />• <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />904 E WESERAVE, SAD FLOOR <br />STOCKTON, CA 95202 <br />APPLICATION FOR UNDERWOUND TANK RETROFrr, OR PIPING 1115a1R PERMIT <br />THIS PSWT EXPIRES 00 DAYS FROM THE APPROVAL OATS. AO NOT WRrTE IN ANY SHADED A$MM. WDICATE PERMIT TYPE BELOW, <br />TANK RETROFIT SING REPAIRlREMINrr _UNDER D15PENSER CONTAINMSW REPA URETROFIT <br />_ -- <br />i-----SPA--------------------------- --'-" '-------------ie ZBL9F3i0PIE __••___-------------••_•_----------------------- ' <br />1 I(L©�O�Z�. g < - - ---------------------------- <br />----------------1 <br />P '-V QP_ C -`i__ y.S,=' __ t�_ __ To S oP --------------------- p <br />A+-------- --- ... - <br />{ C s ----------------------------- <br />T � <br />+ _ ---- --- �- -l <br />L' } v�oss sTFs>t/ -LF --------------------------------------------- <br />- t <br />T IONAWO 1,1. T \------_'-------__----•-•_• aO�i 03 <br />------------------ ooNt7t ---------------------------------- ----�-1--•l..G... _ -3 --------I <br />' ! Co+rraaercar ADDRH33 � � ({_ = `e .. '^ �'_° . -1- -- L -C # [� �� ��1. (� <br />C ! <br />---------- <br />oT= IBFamQITIL3T ----------------------------------------------- ......... <br />H --------------------------------------------------------- -------------------------�" -, <br />' ------------------------------ <br />M*Hz # <br />...1!`t1l=lllltfllfl IlI1ft1111111fIF ------ --- ------ --- --------------­---- -- ._�---------------------i <br />TANK EDrIZE ! otzszx DA VST IMSfALLBD ! <br />I t 3 s- 'i �e c —0 <br />iTt39 _ <br />1 A! 89- w, ! I 1 ( i I <br />I F ! 39- (• I I <br />1 K ! 39- <br />1 t 39'� 1 l <br />t I , <br />-p-`11i{1ttl11llF6 111ttiF :t I�i:1141111I t llttt111 1I ,11111'! Iblf 11.:1IItt111 „ is 1111 11 l „ tlltllitl[li� <br />y I A"Roiil3D APSRom W=X COXXTION (S) _ _ DISAPPROVED l <br />N ( $i.AN RrRV iERS t5S8 A1-rXCRIMT Wr= :�F I <br />allllaatllllttltttt111{111ti1 I tll4lltilt r�lt{II11'll1 i l'[ltt 1 t111t1tt I!llilI <br />I IT7111 1.111 111 ITIFTITIIIII,III : <br />I��TZWS OF <br />( APPLICANT !DUST naVO M ALL WORK 10 JkCC�1DRNCE WSx7! SW JOAQUZDJ CdC#1T7[ �IlDWCES. STATE LAMS, AND RJL1 9 AIM p <br />am JOApDIN C aum, 3MV2VARDONTAL W=LTs DEFAR OPM. OMER OR LLG»ED mm's SrMgLT= ==FIRS T'8: FOLLOW=; It CEMFY t <br />TBA= IN m Pwzu&oa= of TBS w= I= i83IC.z Tuts PS1rT IS ISSLTI;D. I SRA1.L um maLDY AW PIIt M IDI 91DC1i A PUNMER AS TO 1 <br />( 8EC0!!8 S11w= TO ATolln's q@!iFItiXM=M LABS CSP CAF+IP=W1A," COVTVACM-S RY 7= 08 S L'II1M SIGWAT= 03LTI$7ES T= <br />( sI CITIFY THAT UXO>? "M A�RiFM grog TRIS Fe»? IS issu o, I SRALL PERSONS SCJO== TOFoumm; 1 <br />1 SIORECR I S CO! ZP*XTIOB LANE OF V. ✓`-� -►/ t <br />l 711 <br />3 1 g I a 3 P i?� • i <br />1 APPLICAb=' S SIC,NATUM. 4, TrrLs— I <br />+------•----------------_----------------------------------------------------- ---------------------- <br />BILLING INFORMATION: <br />Indicate the responsible party to to billed for additional BHD 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 a must acknovvied responsibiBy for the billing by signatu and date below0 Lf <br />ivame_CGI F"- >k S <br />Address 3Q 4 o N ' �i� r� �{ ��-� _Phone # 2A31 32 SOON <br />EH230038 <br />.(revised 1131102) <br />