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LJ <br /> Ell 00 14 (REV 3/94) SAN JOAQUIIV COUNTY <br /> PUBLIC 11CA1:1711 SERVICES <br /> ENVIRONMENTAL 111TAL'I'il DIVISION <br /> 1 PUBLIC RLCOIUM 11ELEASE AITL1CATIONN�,�\ <br /> APPLICANT-.i49,1 11 , - _ PlIoNII <br /> ADDRn55V,3,�C27 j��D�o Kms, ✓YIix> ) _ _�1� L <br /> AOP.NCY NAMII�FT� f— WONE NO <br /> ADDRESS <br /> fill �dd�esses i t1 <br /> FILB ADDRESS p AGENT D TB <br /> >#r m l,AI,1-b,�mc'I'kt)-4? (p17 E . Q _ <br /> J ��Cra - <br /> T'I115 NO'1'ICli I5 SUUJECr 1'O 11113 R)!Qt11RL?MI N('S IOLN'I1FIED IN Tllli 1'UUUC 11L•ALT 1 <br /> SIiRVICIIWP-NVIRONMLNI'ALIILAL'I'11 DIVISION (CIIOJ POLICY N94-0UT, ORDINANCQ COU1i OP SAN <br /> JOAQUIN COUNTY, LIID PEIJS AND SLRVICE CIIAROI3 AUSOLMIONS, TrATH WATrIt C01111, <br /> COVERNMuNTCODI3 AND'11113 LVIDLNCI3 COOS. <br /> 1. A MAXIMUM op TEN (10) rRBMISR ADDR15530 rER REQUL•SC. <br /> 2. I'DBLte PILLS/RECORDS Rl3VIEw D BY APYg NL r'tt1LNT_QAU. All"U'rMIRN7S ARB ARRANOC+D NY <br /> CALUNO (3V9)469.-034(7- OFPICU IIOUR9 FOR APP017FMP.HT0 ARR !C'HUHILRD MONDAY T11RI1 FRIDAY <br /> I!XCLIIhINC/ IIOIJDAYS, 6:00 AM 1*0 12:(X1 NOON AND I:OO PM 10 4:30 PM. <br /> 3. A IMILIC (IECORDS IIELRASU APPLICATION (1'RRA) U REQUIRED. <br /> 4. I'llbl_IC PIUSIRLCORDS Nor RNIURNEo 114 THU SAM13 CONDITION AS RECEIVED WILL R6 CORRECIL'D <br /> 9Y 7146 C-110 ATAFP AT 1119 tI".H!6 OP TIO{ AM'LICANt. TRL7 ADDITIONAL lBRVIcR WILL N9 BILL61) TO TIIE <br /> APPLICANT FOR PAYAIGHt. (SPH LIID POLICY 944W) <br /> 5. ORRIINAL PUBLIC 111-115/RECORDS SHALL HnT NR RCAIOVRD PROM 1119 Lill) FREMim. <br /> WINA'IU M Olt AITUCANT DATI3 <br /> SIONATURE OF RI-3.11ASINO OFFICIAL DATA <br /> No 1'NS/EIID RECORI)S/FILItf ARII IDem ortD: <br /> n.n, �r+.Yn... IITRMYMM n.m <br /> ITIS/LIID RECORDStRI-81 RX I.. ON TNR ADDRE79(ES)NOTED. YOU witi 6E tlan"Rp WIl9N <br /> IIICCORIWFILP_7 ARI, AVAILABLE FOR REVIF.WV <br />