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A?PLICA7.100 7; -VX RZTROFIT. JR PT Y';dG -4.FP),IP PE;ZMXT <br />eF,u,--- IC _'ZRIS 90 DAYS "C-" Tt-:!: A-P'PROV;.:- aX-' Do 'qOT !(; IF Al:'f SUX:ZD ARZ.&S- IYD-CATE PERr.IT <br />-.TA.\7r — PIPZ.NC UrATR <br />Z;,A S r -r-- :z--. --I <br />;,kO11,E(7r CONTACT &TELEPSCIc. <br />209 461-6337 <br />.rt ` <br />7 7 G ca. <br />c ELITE V CONTRACTORS, INC. 209 462-6337 <br />1 co rrRAczcIR DDREss 2535 WIGWAMDRIVE CA LIC 6 6 0 0 16 <br />r — At C, 10, HAZ I <br />jc�-Je 046-008761 ► <br />C crtmp <br />PHONE 2 <br />Ft i <br />I I r. 11. t 1. .... PHONE 3 <br />SIZE o.1E;,i1CAJ-S STORED CU2SLEN`MT/P-REVXOUsLT-F DATE UST 3XMLLAM <br />35 <br />v <br />SC 1 35, <br />A ROV.D P�'Tz-wm vy, <br />PP. Tn ON ISI ' DISAPEROVFD 1 <br />ZE <br />II- <br />ZE <br />Pk DATE <br />I I III I I I I I III I III JIM I I I I I 11111111111111-111111111 14, Auvl) <br />.t2nic gr XU= < li:RFORn ALL WORX :0 ACCCXDVWC{ SAX JO.'.QUZ?j COWIr OZDL'AX=� <br />--ATE LA -S• ZL-rzs <br />X,.,)uTN C--WytJry ?(MLIC HEAL -3 -IZR%/Ic-1 C"'ZZK OR LICENSED ACIX-S SIG� <br />AAT -"L, C!RTIFTES THE FOLZOvqbG- -X CE3t2-ky 7[XA:r Inc t <br />OF -THr UORK Foa '.naCH THIS 2rr is jssU£D. I S;XL NCr jMpjAr ANT PER --O" rX -ZGM A MANWOZ As TO BECOME <br />n ,T-11�cj 113 COMPENSkrMc LAWS OF <br />. COKMACTOX's OR --IZUBCON-c5tCTZNG SjG.v;L--LTE CE-,rlFxr:. TaE <br />kERFOPC -V(ZE OF THE: wr':Z- FOm WE'CE ;-IfIS PE10n Is !-Sz;zE3). I SHALL EnMoy ?--fLlov.; svi-rEcrM %111AXIMIS <br />OF CAL:FORXXK,-- <br />I UR:' T <br />7-- <br />Ei YLLI3,TG <br />Mrx(bcate the. resP0.11sible party to be billed for additional PHS -UM staff time e.cpended beyond <br />a;>e--* I, <br />=r. payment coverage per tank- If the party designated below is different than the permit <br />zt.nplicant, e:-9- property owner, t party must acknowledge- this responsibility for the billing <br />-1-->y sjgr)at='e <3-nd date below. <br />cz r-�Of-5 <br />)Onme <br />3, Y ss -Q number J0. L4 h1 :33 <br />-;Snature. tit <br />Z-:-11 23-0036 <br />Z- v,,c- 4a*464 4:S;x\3;aA- W-koL- W -Tqev-z <br />