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Dec 24 08 02:31 p Arco AMPM 2098308293 p.1 <br /> DEC-24-2908 L1 : 15 AM SHAWDSOHARPER r-y 6:U. Thio Lao v.. - <br /> I i �.5 p•. <br /> mm JL Kim <br /> Hor-.AL—THDEPA'5'r ENT <br /> L <br /> SAID JOA ° <br /> 600 Eaeit Ms11111 Sire : famlot" 33 <br /> TelePlhonc: (Z09)46 6 } <br /> 1T OR PIPING REPAIR PI^RMIT <br /> APPLICAMN FOR UNDERGROUND STORAGE=ALDaT� p�It YSPEra�rrTYPEt aoW; <br /> THIS PERMIT eWR_ES 180 DAYS FROM THE 10 <br /> nTMW RETROFIT STARTILVR LPC'AADE <br /> (, +iG REPNP)RETROFIT ❑ RE <br /> WC PN RETROFIT �0. 41 <br /> F F-PA She# FA aoo 7 3' Prop�t Contact&Telephone# ti< <br /> A Fal �a --�-. ` CA S 37�' <br /> C. <br /> LAddress <br /> I Cross Street Phone# <br /> Y pwned0gerestor Raw ,'� Phase# sack r'f r• 37✓`'gl 3 <br /> C Cantrar#or game R eA,a CA Lit# �8 3'01. Claw 14 <br /> o <br /> T Contract�pr Address Work Cane# <br /> R Insurer Expirettan Data <br /> A <br /> T IGC TechniCian�s Cartificatia+Number ExplMillon beta <br /> R ICC In8ta1lieet;Certlf caNar Number <br /> Chemicals Stared Date UST installed <br /> Tank 10# Tank S17A CurrerltiyJpratpously <br /> T <br /> A <br /> N <br /> K <br /> with CordItials ODtaapproved <br /> P appall (Se Chrnant With Cor4ftel <br /> L <br /> A Date <br /> plan Reviewers Plaine <br /> REoMATIONS OF <br /> ULES AND <br /> ' <br /> APPLICANT t+Iu3T PERFORM ALL WORK IN ACCOpoANCE WITH SAN JOAOU COU TSORDINANCES.SIGNATURE TE LAMIS AND CERTIFIt T1�ERFaLOS T O CERTIFY THAT <br /> I <br /> JOAQUIN CONY.ENVIR04MENTAL HEN TH OEPARTMEPfT.Owner OR LRAS T4 BtECOME SUBJECT TO <br /> A- CQNTRACTORS HMO OR SUBCOWMIl nNG S'GN TURE CERTIFIES THE FOLLOWING.- 9 CERTIFY <br /> THE PERFORMANGk OF THE WORK FOR wIIICII TTES PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN <br /> WS <br /> i yypRKERS K�MPENSATIOp1 LAWS E CALM <br /> II THAT IN THE PERFORMANCE OF Y>iE WORK FM WHICH TtSS Pe�dtT IS iS3UER.I SHALL EMPLOY PERSONS SUBJECT TO"KERS COMPE"UTION LA <br /> OF CALIFORNIA.` 04" <br /> Tige <br /> Avow�� BIDING i1VFORMA'f 60tV: <br /> nderma payrnent coverage per tW*. N <br /> indicate the responsible party to be biled for nst END staff t"expendedaalrne Me PAY ms,st edge this <br /> the party designated glow is dithan the permit applicant, e.g. P operhr <br /> reWnsibililly for the tilling by signature Ord date bell <br /> �� '• _TITLE p#It�+tE <br /> * <br /> NAM <br /> ADORess <br /> P !lop <br /> 2 to o rcc <br /> , <br /> SIGNATURE RECEI'- <br /> EM230036(r$VWM'2131107) <br /> a EC 2 4 2008 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br />