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APPLICATION FOR LIpU10 WASTE PERMIT <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />I ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, STOCKTON, CA 85202 <br />/. (209)488.3420 <br />1 (/" ROIFIIEFU11OARE PEIIMIT EXPIMS 1 TUN 0M 01<�JJ TE (t>�IIEO <br />ICwmMb Is TrrMuu) <br />ATION N MEW YALE TO THE SARI JOAOM COUNTY FOR A PFP0xT TO comwr UCT ANDAM PWALL TPF WOW DEWJVWD. TM APPLICATION N MADE M COMRIAlCF� WITH SAN <br />JOACA M COUMY CH AFTER W 1 110.3 TUE R SAN A COUNTY PUSLIC NMT14 b. K HEALTH p\INION. <br />JOE ADOIEEWR A.^HF C crrY WT ME 41& <br />OWNER'E NAME�� � /- ADOPESS PNONIE�„ __._ <br />CONTRACTOR "�i ADOIEEF (39,I1CJ PIIOWE <br />am CONTRACTOR -,I' <br />o- /VL. AOpE\oto UCF�TO� <br />TYFS or germ FVOM1t: NEW M\TALLA. POPANIADOIDUN n vwTRUCTIDN ❑ <br />/NO N7TIC SYSTEM mnoxn D F FVNIC NFWFTIVAR.ACIE VMHM 200 FEET OF SutDSNO.I PEIC T1S►4. t 1 WJW ASAtY <br />IIPPSDMR /_ <br />IIrTALL11TION IMLL AMIVC R �i oMME71CUl ❑ OTTIEA ❑ <br />IRI,EEU lM I1VFN URTS:�TSR ®1100MS: NUMBER OF MPLDY6\: <br />Of SOL TOA 00. OF TPF.T:_ PITAMS.R CNARACTEIF. WATER T. OE)•Tl� � <br />p ME TRAP ❑TYPE — T' CAPACI/.P10240 <br />NO. COWART ~@ cAl <br />PRO TFEATMEIT PLANT ❑ NSTAM:F TO NEM1C\T: WELL ►OUNDATTONly,Z� MM"" UM <br />ERT STATEN ❑ FQE TY14 CF FAFAP OR pnAFACE TO NEMER:: MI'ELL� PDtIOAT10NPOUWATON lD <br />IEAONSIl1 IIIIF . \ LEPOTH fH< lN! TS T/ i�1CT) <br />PETER SED D WIDTH IEHOTH_ DEPTH DISTANCE To NFAtEU <br />FN WELL FOOIO <br />ATIDN PPEETTY LINE <br />\EOtoudo ❑WTOTH t000rw ^_ omH pFRE <br />TANCE TO NEAR: VMI_ K'UPAATW" POOPEOT LIE <br />®11a R <br />ETE 0 DEPTH FIZE PMEdER OIFTMNCE TO NEAREST: WELL MuNDATWN PROPERTY I" <br />— <br />news ❑•� WROTH LEFOWM TO M� <br />^ DEPTH DISTANCE ME:T, WHL ERIE — 700"DATION ROPY E <br />DEPOSAL POLOS 0 WIC" MOM— OSTM OMTMICE TO NEAPEFT: WEE—_ FOUIDATON PMOPPIY LEE <br />I HERESY CERTIFY THAT t NAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL M DOME M ACCOPDANCP WITH AM JOAOUIN COUNTY OIESLA►EYS AND STATE NWS. AND Mn" <br />NO IEMLMIOFM tW TEE SAM JOA01M OOINTY. HOME OWMM ORLICL.WEO AGI NT'S SISNATUM COTTWMS TIE POLLUV~s'ICERfTYT"T M TUE PESOPMAM" OP TUE WOPK POMWAFCH <br />TIM PEMIT ■ SIMLL NOT WAKDV ANV PERSON IN SUCH A MAMEH AS TO SECOP.IE SUSJECT TO WOIKI6Wn COIM'ONATON LAIM 0/ CM/pISSA.' COMTRACTOWN HSEM OR <br />CIRTiE/ THE FOLLOYVNO: 1 CEMr WY TPUF IN THE PE/SOIMANCE OP THE WOM FDA WHICH TMS PERMIT E EMIED, 1 MNL E\E4DY POEONO SU\JECT TO <br />waNKALAw T LAWS OF CALIFORNIA.' TIE AFPin M HOt/E N ADVANCE POR All. IMNV D SSSPWTBD E. COW"W DRAW" WOW <br />r' <br />map" tTTLE:_ t' ,' MATE: <br />PWT PIAN [MAW TO SCALER SCALE ro <br />1. POLES OF OR ROADS NFAIESr TO OR SOUNDING TIE PROPERTY. 4. LOCATION OF ROUSE SEWAW OMOSAL SVSTS A OR PROPOSED <br />2. Outten OP TUE PROPPIY. WITH DIMENSIONS AND NORTH DIRECTION. MAMMON OF SEW PAR DNPOEIAL OMMIMI. <br />J. owaH o tD OUTL1tS ANO LOCATION OF ALL ExETINO AND PROPOSm STISKTIE►, S. E LOCATION OF WELL) W ITHN RADON OP OW MNP® FIFTY FT- ON <br />N411ONF COVERED AREAS NKH AS PATIOS, DISVEWAYS. AMD WAW. TUE PROPERTY OR AD"" PLOPWTY. <br />ARVCATON ACCEPTED SY <br />TANK, RT OR KW WWWTIOH <br />ADDITIONAL COMMERS: <br />FOR 09APTMER USS OIILY <br />DATE I I FINK INSPECTION" <br />Pun Heath SOTV.. ETrv4o. 174 (3198) S d D Z 2 3L A C\ <br />