Laserfiche WebLink
FACILITY INFORMATION <br /> Business Name: �.� e� P6���T M PP�J /rJC, <br /> Owner/Operator Name: C(� -Pcca.ITE.� C O Pf�nJ t C <br /> Street Address: 171 0O P,Ljq#V <br /> City: L-ATH R./o d C(4Zip Code: 9.5 33 D <br /> Mailing Address:—:P-,-Q.. k30VC ;72 7-4M IP 0 - a5-33 C) <br /> Phone Number: Yo?!Y�0 V <br /> APPLICANT/CONTRACTOR <br /> Name: SE. m Gy _. <br /> Street Address: 3 J }'t/�ST l-�F3 T� ., 004 Q ... <br /> city: M006 sbv Ll F- Zip Code: 95&s/ <br /> Phone Number: <br /> Contractor's License Number: gy926 y Class <br /> Certificate of Worker's Compensation Insurance on file with PHS/EHD? V YES NO <br /> UST SYSTEM BLUEPRINT INFORMATION <br /> 1. V Four complete sets of plans (specification sheets and/or equipment <br /> brochures if not on file). <br /> 2. ✓/ Plans drawn to scale in non-erasable blue print. <br /> 3. Plot plan to show location and number of tanks. <br /> 3 <br />