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(,2�12/97 15:58 $510 746 4232 rT&S LTC Z003 <br /> 02/12/97 09:58 2219165633 HLA SACRAMENTO 4004 <br /> GENERAL PMRRAM fllE f Now Chant Edit (PRO03) revived 5/21191 <br /> FACILITY 10 1 1,4-1rndllh euc <br /> Rg=o ID P �IG � r`n Palo* SLEEPS/C'01P / �L "1 ) 6 <br /> ` �o �0 <br /> DAIRTt Dreft A _ Cede R ` Milk Dispenser y Nudrer or Containers in Multi-Red unit <br /> rOODI Restaurant MarketCoetnletary Nobile Food Produce Stand lee Plant <br /> saatbg Capseley so it Market -/food rrept 7 / N <br /> Teeperary laed Facility — special rad Event vemine Haemes ^ vtAter of vending units <br /> feed Vehicle Kok* License R _ eegistrettai a Cela, <br /> HAZARDOUS WAIIEF ^ Tom Cenerstd/Yr TIEAED PERMIT Facility t CA _ CC _ PSR _ <br /> NOUSI1101 . Rotel/Notal. _ No. of LMts Jail/Exmpt Institution _ Rousing Abotaeant <br /> fnplsyte Mopping � No, of Fwplo"wo Alpraa DaTes of Occupancy J ! to <br /> LIQUID WAITE, Putpr Yehlele vu, r Tsrd_ Cheelcal Toilet* No. Pelage TM Plant _! <br /> MEDICAL WASTE, PreRary Care Acute Care SkI1 tad More Iry La Cenereeor _ SM Cernerster <br /> Stere" (Z-10) _ steres, (11-SO) _ Storage ( +SO ) _ Trrnafer Ste _ ltd Maoist _ Vee elinfc �- <br /> J <br /> RECREATIONAL HEAUM: Peel/Spa Timber of Pools Out of Servlce Poet _ Metursl Bathing Placa <br /> SIYE HITIOITION11 Environ ASS011 usr/FAP Loc Nes Waste Mer Mat PPL <br /> Other Lead Agility Site YL Agercyi RWDC9Oise NFL Site — ROIN20 0 ^ Other <br /> SOLID WAS79- LordflIt Transfer Its Recycl Ing Fee Waste Storage Sae _ AS Vasce/Exeapt Site <br /> ale YMlole Me, DVnxter No. Stationary Catpetor Stte - <br /> 141 <br /> VECTOR CONTR0.7 poultry ram — Max Mud"r of sl rdr Fentel t,ylt"- <br /> Vl c <br /> EMERGENCY NOTIFICATION for this FACILITY and/or PROGRAM DAT tg <br /> oull <br /> CONTACT T'T AJO_Pj L _ (._) ( {�V JOAOt' CES <br /> CONTACT 2 7 <br /> OFfiwAYED wKOTEE Is Ivi ,� I PROGRAM ELEMENT S f^� Wakrut STATUS <br /> S OF UNITS 7 EPA 10 0- INSPECTION CODE <br /> SILLIRC std Wt►L INCE AORHO)LEOGEMENTi 1, the urdsrslgned owner, operstsr or pmt of eau, aciteataidpe that all ells and/or <br /> project specific PHS/END hourly charges associated with this facility or activity will be billed to the party Identified as the <br /> RILLIMC PARTY an We torp. 1 $lea Corti that I have prepared this application and that the work to be perfomed will be done <br /> in accordance with all aPPIlcob SAN I TV Ordinance Codes od/or Standards and stats and/or Federal Ewa. <br /> �APPLICAlif•f SIOMTUtE i <br /> x X y/fs1� 7 +ke loll <br /> TfUeT �✓ Dae:_-____� <br /> MITNMIZATICN TO RELEASE IN! TION: In oddlticW to the above, when applleshts, 1, the owner, operator or agent of este, of <br /> the preperty'loeaed at The alwve site address hereby utherlss the release of any and all results, geotechnical dao and/or <br /> enviromentetfafto alae nt InforRMtitn to SAN JOAQUIN COLPITT PUBLIC HEALTH SERVICES ENVIROMEkYA1 WEALTH DIVISION ae loan n <br /> It is avollable and at the am it a provided to was oe w representative, <br /> fee "t Raoult Feld Data of Psynmt potash Type Ateelpt R Cheek S Reevel gY <br /> -cc qx <br /> /_/_ ACCT met CLK / / <br />