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y�-- 10—lei-1594 11:03AM _f:R@M'/Q: /r�r�cr�G� k--aJDrid 11 <br /> ill'! . 191644320831Q <br /> oERMAL P90CUM t<ILP : new ,/ I <br /> YACILITY W.c ~ ase�� Edit Y � <br /> PAQ rff +nr►ised SAIM <br /> PRIMSWEI:P$/gp ' t Qrstribul, to <br /> DAIRY: Grade &,a*i� Glade B i- f }- f the Plumbing,P'�Art9,Air C <br /> L Df onditioning,Ref' <br /> �sg4% <br /> —�. +.-.-. ftmber O f { - ,r�b '� d - n9erat o &$heat <br /> Metro Ind <br /> Rasc <br /> • •seat� lyarket",,,•.� CMapi �� -i� ""`'sl. ,,.,; , -^•, .. + <br /> T�peraryprecity Ft 's'—� liabite a.. DIANE SC I <br /> acid F 3 H <br /> F acitfty . . Market viFfl �XaCulivas2Creftrr AUBgCH <br /> iIEhFCI@ �� SAaciai FM e - Y <br /> itcc Z } <br /> �.,.. ""-„�—� Lfcq t�. yenditag � 4k O.BOgWa Pa tic Blvd.(sss�a a�8y).. <br /> +te tUwe.., <br /> ;SAcrnrnonto,CA 95852•i6a7u <br /> wa Uwe. , ( =; P. <br /> iO 'etkd/Yr T!E&ED - 329-3789 <br /> xone.{976}'4a3-2083 - . '*...� 4 <br /> �..._ IiOilBlliCt H�stMatvt :t0. of t>aifta <br /> C4 aWtOYM w� Jai1/E�oeApt`[risrYttizsK:ff _ `�u'@ p1 a <br /> *.*�--•.-�— ApPM aatea of. y ! "-_ _ r,v <br /> •—��r.`� to m" "" 'Wr <br /> ,� f.I�tl�b #1AS'TE: f>tkr�r �►ehiata ;,s—�^--- <br /> �._ AMalper Yard._ Chemieat Oaf Lets leo. <br /> ,�.. Package Tx Pta t 4 <br /> MICAL WME: Primary Care Acne Care Bkftled HumIrd LS 'generator Sm Geewer or <br /> Stari7ge {R-l0i.�� 3torege It1�S03 `4 'Storage < s50 y �„ Tran9fer Eta f Ltd eaular _T V .Olinio r-- <br /> Ln <br /> REGAt1O1iAL NEAt:TN: P9olf3pa,,.,.. tuber of Pool$ Out of Service Pool Natural Bathing piste <br /> Ii :! <br /> �iTF MITIMIOH: EM run Assess ' UP/GO _ Loa Nat Uaste �. Nes 16r PPL <br /> other lead A 11Cy Sita Agettcyx RigCB aTSC XPC Site k N AQO 4 other <br /> SOLID VASTE: Landfitt Tratsifer Ito RaMLing Fac vast* storagevaste/E % Site <br /> SW Vehicle go. Osupster go. Statiarmry Coq=tor Sito <br /> HECTOR CONTROL: : Pouttry Farm RM Hiner of Birds Rerreyel <br /> EHHRGENCY ktp incavium for this F=LITY and/or MOWN p DAY NICHT 1 <br /> h <br /> CONTACT 1 t ` '.F L--•--) <br /> :i DESIGNATED EMLGTEd 0 PRQl�4 ELENUT D I=RE WATUS <br /> yy <br /> D <br /> OF UNITS : EPA !D t#: iP Itt.�P£GCION Cd3E i <br /> 3 <br /> BILLING and COMIPLIA116E AUMM.W6849NY: I, the wdersigned owner, operstar or agent of,�saw, ackmoaledge that all site a W*r <br /> project specific PHSIEND hourly charges associated ulth this facility or activity uItt be billed to the party identified as the <br /> BILLING eA$tfY on this form. I also certify thav I have prepared this appliaaNan and the= the wrong to be performed Vitt be dam <br /> in aroordance with'ai.L apptirabl SAN"JOAlNkIN' Orli zWor Stattdartts' .la� Slate and/ar Federat"tails.' " <br /> APPLICANTfS.SIGNA x <br /> Tit[e: 64� ;1_ C f� palet dr� �y <br /> mTHOR17ATt0N 0 RELEASE INFO MATIONS In adds on to Ilse above. when applicaKi, I, to owner, uWator or aamt Of Mme. of <br /> the property LwAted.at the abomm site address hereby authorize the release of any and all results, geatediniral data and/or <br /> envirorne wtal/slte assessme a Wermation to SAN JDAMIN MUNTY PUBLIC HEALTH SERVICES.BViRONIIENTAL NFJILTN DIVISION as soon as <br /> it is avmHuble and at the setae time it is Provided to w or my reprauntativa., �p <br /> I <br /> Fee AwAwt Augunt Paid Date of OftWit lsayMont TYPC [IRseaiAth a Check # Rcevd Oy <br /> I�. F <br /> 4 <br /> REHB ACL`T i' I 'll LMIT CLIC <br /> f� TOTAL P.03 <br /> I� <br />