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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBUC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE.STOCKTON,CA 85202 <br /> (209)468-3420 <br /> MON N0114ABLE PERMIT Rf3 1 TEAR FNOM tIU 9MD <br /> 490 p4Fv it TAFRBBTN <br /> FOR A IEIrAR TO CoHff :t AMIM MWALL T#WOM DRICIUM•THAT APMICATION N MADE W COAEPUANCE W1T11 BAH <br /> APPLICATION AB fENLRY MADE TO THE BAN JOAOM COUNTY ALL WALT"DMOM- �^ <br /> JOAQUS/eauTttY OEV[LOFMENT TTtt.E L7N1/'TBII Lt t 10.7 AND srw/oAloe OF IAN JOAOUSL CdIMTY AISLK NWTN SERMCEB.ONtlOMM91T -.1if 1'c' <br /> Y Lot ISM <br /> .EDS A0001981001 APNI <br /> ADO1R800 PHONE <br /> OVIWWB NAME nO <br /> H <br /> CQWPIACTOR <br /> (�J <br /> tICF F11011E <br /> ADPIFDO <br /> eve caNTRAeron <br /> MEW MMTALLATIDM❑ eeaTRlIDTaN❑ <br /> TYPE OF OanO WOICIL RpAl11AAOO1T1011 <br /> PEC TOTW I 1 NOMI MANY <br /> SAO SErr.SyM.,,,PEAMTTr_F Mf8L1C SEWER 10 AVARAML M"011 200 FEET OF KMD004 <br /> AFFB"FA e- j <br /> WSTALLATIpM WNL 88fVL R[SIOENCE COENAEAdAL❑ OTHER 13 <br /> N11,aim Or omovET3: <br /> NUM0E1 OF U11SM IBETE:,-,_-,_NSR of BBDFfDOMe' WATER TAKE Dogra <br /> MIAPACTER OF BOK TO A DEPTH OF a TEST: PITASIHAF SOK CHARACTERS <br /> CAPACITY Na-COAIPAIRAEN'TS <br /> MBE <br /> GWM TANK/BATRAP ❑TYPFMFO MOFEATY'il1E <br /> NCO TRMTMMIT PUNT D DISTANCE TO 301~-- WELL <br /> LFT STATON 13 MZE TYPE OFMNAP SAND OK SEPARATOR SNCLOSEO SYMTFIAI L <br /> h A!�—�Qp` aeTANCE To NEANEBT:wnl FouwwTwE�S I FaoFEmv uNE <br /> UACISNO LSA[ W.S LENpTN OF UTAF.e FOUFAATIDN I,ROPERIY UAE <br /> PILT01 an ❑WIDTH tBEBTH OEPTH DISTANCE TO NEAREST:WELL <br /> DISTANCE TO MEANEST!WELL FOUNDATION MIDFEATY LRIE <br /> MoMm 13 VMT14 STH DtM aerANCE YO IEAIESTs MAELL MwNBATImT rno++•:nnTY uHE <br /> SSaAa[Me (]OOTN eIZE tAMSER <br /> D10TANLE TO NEA/1E0T:W&Iiat�ATlON ���LNF <br /> BwRS D WROTH IEHaTH off""— _DISTAACE TO NEAREST:WHL FDUNMTIDN MMFERTY UNE <br /> u <br /> wsPot POND$ o VADTN UNN" DEFTH <br /> t HEREBY CEI1TiFY THAT t NAME FRPAPO TMS ArrWATIOW PT ANO THAT THE WOWILL BE DOME W ACCOPOANCE"T"SAN.IOAOUIN COUNrY ORpp/ANCEB AND STATE LAWS.IND"UM <br /> eOtMTY.IpyIEpWSERORtC[NIBED 40Wr'S 00NALTUIE GEMIFES TM:reLLDWBSSi'iCa""T"AT MITHE FNBOMAMC[of THE WORK FOR WMCM <br /> AM RESIRJITMMBOF TRMSAM JOAOLAN A/1Y p"pIT11 Sf SICN A MANNd1 Ai TO 8EOOAAE SUM/[CT IO WOR 144"COWENSATIOH IAWB OF CALroppa& CpHTMCTOR•S MWINR On <br /> TMS PSAAIR M MSM/OWL NOT of THE YMORC FO/INASCNTNlt PMMET b SISIRD.I SHALL EMPLOY PE04000 8USAECT TO <br /> csravwS THE FOLLOWNO:-I CERTIFY THAT W TIE r9FOMAANGE 118.CONTE WAWM 8ELOVY. <br /> WpllCMAN'0 EK„pr'a�UWS Or GALFO TME AWJCA T MRIST CALL t4 NOW M ADVANCE POR/ILL IROIBIw STSFfC'OO <br /> ( � nU:_ G <br /> TFS r� <br /> BlorEn x ”` I — <br /> KW PUN MAW TO SCAUD SCALE le— <br /> I-"OAKS <br /> I-"OAKS of srR¢TB OR POAW MANWIt"'O ORSMINOMM TIE rOOPELDY. EP O(FlppRp[R pFfEWAER IMOMLMSI'!MB- <br /> 2.OURJNE OF THE MgF6RN.WITH DEBBMWMB ARD IIOITTN aR�TION- [�� E4 FCB-LOCATION OF WEBS TS OF ONE M NDWO rFTY Fr.ON <br /> 7.DIMEINgOEED o1FRSAee AMD tociaMMOF ALL MOSTIND ANO MIOMSED OTM=rUFWS• r ls' T/IE MIQFHiTV MTAOiD <br /> MCLU MM CO46m SDCN Al FIORDS:O-A-AAYO.AND WALXS- - ...., .... !, <br /> _.. _• .. <br /> UYY <br /> • J• <br /> ON <br /> EA <br /> a <br /> S' <br /> r <br /> f <br /> ........... <br /> .... ... .. ..... <br /> .......... <br /> ............... <br /> .......... f <br /> f...... <br /> ............... <br /> `M....: <br /> ........... <br /> -... <br /> ............ <br /> ....... ........ <br /> 7p <br /> ............ <br /> •A`'V`A7�RK//)i�1 f. V^- BATE <br /> APRKAT1oN ACCEPTED:DY <br /> DATE f f FIRIAI SlBFEC1ION by DATE <br /> TAMC,PIT OR VJMP INMCT G"Ov <br /> ADornoNAL COWAW 8: <br /> ACOOUNTIIIO ONLY: <br /> NDF FACS <br /> - RBC Sr DA M MT <br /> /AWM *WAN% WYDCf/ <br /> PF toD[ FSE HMO AAEOVIIT IIMEi C <br /> a 'D 7133 <br /> Pub.HFBPoi$BIv.-Enviro.174(IN) <br />