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ENVIRONMENTAL HEALTH DIVISION <br />APPLICATION FOR INSTALLATION OF UNDERGROUND TANKS ARE ONLY VALID FOR THE CALENDAR YEAR IN WHICH IT RAS BEEN ISSUED. <br />A PERMIT CAN BE EXTENDED INTO THE NEXT CALENDAR YEAR IFA LETTER 13 SENT TO PNI REQUESTING THIS EXTENSION THIRTY DAYS <br />PRIOR TO THE END OF THE CALENDAR YEAR. A ONE YEAR -- ONE TIME EXTENSION MAY BE GRANM BY PNS -END UPON RECEIPT OF THIS LETTER. <br />DO NOT WRITE IN MY SNADED AREAS. <br />vs <br />E 16 917 <br />umjl <br />TANK 10 <br />9 <br />3- LqQ I — 0 <br />39- <br />39- NINE <br />39- <br />39- N <br />39- <br />39 - <br />APPROVED APPROVED WITN CONDITIONCS) DISAPPROVED <br />�=AIVACNHEMT WITH CONDITIONS) <br />PLAN REVIEUM NAME DATE <br />APPLICANT MUST PERFORM ALL WORK IN ACCORDANCE WITH SAN JOAQUIN COUlNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS OF <br />SAM JOAQUIN COUNTY PUBLIC HEALTH SERVICES. (AMER OR LICENSED AGENT'S SIGNATURE CERTIFIES THE FOLLOWING: "I CERTIFY THAT IN <br />THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SNALL NOT EMPLOY ANY PERSON IN SUCH A MANNER AS TO BECOME <br />SUBJECT TO WORKER'S COMPENSATION LAWS OF CALIFORNIA.w CONTRACTOR'$ HIRING OR SUBCONTRACTING SIGNATURE CERTIFIES THE FOLLCWI <br />ml CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSI I SHALL EMPLOY PERSONS SUBJECT TO WORKER'S <br />COMPENSATION LAWS OF CALIFORNIA.m <br />DATE <br />APPLICANT'S SIGNATURE: TITLE —2,2 —?Z, <br />EH Z3 OW (Rev 1/7/92) WP <br />3 <br />P A Y ME NT <br />FiECEIVED <br />J U H 0 5 1992 <br />SAN IOAQUHN CO3lNTY <br />I - <br />PIUE311-16 HEALIH SE'I'VOS <br />ONO - <br />