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83/11/1998 09:17 120983,`.52 WRIGHT ENVIROW AL PAGE 02 <br /> SERVICE REOIIESI (Ell 00 61) Revised 6123/97 <br /> fACll lfl 10 R RECORD 10 a INVOICE R <br /> f-At ll lit NAME 11 FILLING PAATT ! r\ / w <br /> SITE hDORESS C \J <br /> Tilt CA ZIP_' <br /> YNER/OPERAIOR5 ���I � l) PARIT Y J <br /> N <br /> DPA PlICNE n (.26q) q3 • _ <br /> ADDRESS DO Prime a2 t_)_- <br /> r <br /> Clf -"_..�..�.._ ... S)Ate ZIP <br /> nal ■ �tnrwl UFa Appl Testu• R <br /> ROS DIeI louuen CWs <br /> ONFRAC100 arwl/nr <br /> a" Q DIl LI t / N <br /> ERVILE REDUESIUR �l7!';��\ (\J. 1b(\ NNG_.>,�L—� _�C.r(JN6 PARIT <br /> JC_� <br /> J <br /> ORA PIN;gaE a1 (O 0) Z-�(_.� <br /> AILING ADORER[ , FAO IF (�)IiL <br /> CITY DTVI STATE _ 2fP <br /> UtlllRG ACRNUNLEOGFNENT: 1, the wvlerslgned owner, operator or DRent of tome, stAlNowledge that all site sr,dlor project speclfIc <br /> PIIS/ello hourly chnrgea associated with this facility at activity will Ga billed to the party Identified as the 11LLINC PARTY on <br /> Page I of this fern. <br /> I also certlly that I have prepOrtd this application arvf that 0e work to be perlarred will be dorNe to accordance with all CAN <br /> JOAOUIN C"f1 Ordinance Cade$��a/t/'�/p�t taa"Ln�d{"aarrdds. State and Federal Ines. <br /> IPPLICPNf•1 SIONAPIRE <br /> t11tlIIAIJAIION 10 RE(ERSE INFIMNATION: In adlilluN to the shove. when AppllcAbte, I, the hurler, opeentor or ngent of sham, of <br /> pie property locattel rat the AbOve site Ockirtst hereby nutOorize the ralense or ally and all results, geatechnlcnl dots card/or <br /> mvl tornanl sl/alta sarecanent InformnNen to SAN JOACAIIN COUNTY MIRLIC IIEALIH SEAVICES ENVIRONMENTAL IIEALTII DIVISION OF soon e[ <br /> II Is AvallAhla owl at the RmIP Ilnrt It to provided to rte or AN Feprctentotivn. <br /> Serrlcr [ab <br /> NRIUra of service Rat}wet: <br /> Ass19rued to <br /> Esptoyaa Y beta /-I— <br /> Dot, <br /> /Date Service Camlelld <br /> further Acllan RoONited: i / N PROGRAM ELEMENT _ <br /> fee Amount Amount Paid Data of h)Inont rayneylt Type <br /> Racelpt It Check a Recvd ay <br /> .- .- - - :•i_i T. .. .:' .gin. , -. '� _'/ - IlwIT.r1'r J ./ <br /> zoo 'd 0£bb T[8 60Z:131 A110 90: 11 (03A)86 '11- Nvw <br />