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APPLICATION FOR LIQUIO WASTE PERMIT <br /> ' SAN•JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 988,906 EAST WEBER AVENUE,STOCKTOR CA 95201588 <br /> 1209)4983420 <br /> • NON-REFUNDABLE PenW EXPIRES I YEAR FROM 04TISSUED �y. C�+ <br /> MAS I.M 1!Td,8.4i Am it IDS-CnD J Y D <br /> NA1CAMN IB HEREBY MME TO THE BAN MAW.<AUNTY GOR A FE <br /> NAT Tl<ONBigVCT ANOIOq IN6TNi THE NOR(pE6<NBFO.MIAARLf.ATgN IB MADE M COMIl1ANCE'Ar",BAN <br /> bAOVM COUNTY pEVEIOMEM TiTtF,CNApIFA&1110.0 AHO <br /> TIE eTgryDARES OF BAN JOA WIN COUNTY FARM HEALTH a PRMEO,ENNIgNMENiAL HEALTH OMBpNJ�(. 03 <br /> JDa MDnB6Aq AFNP I �)♦4'' ��� ,v �l.Y cm D�IPon LAr SNE RA <br /> ..'SNAKE QLZP,flIMn Roma IpptE00 <<,,..! wmE �.3�C-7a 3H <br /> CONTRACTOR V311ft. li-B.l- AnwEes pn 66e f.so YJt�la}.�,L 553 L_s ( nyfr �wDNE}35�iTz <br /> BOB CONTRACTOR <br /> IICI PFHINE <br /> TYRO 0'..WONC XEW W6TAWTpN❑ BfPNNAOgTpN GK DfITNI m❑ <br /> NO SI SYSTEM pEFORMS'IF MR `EWER IS AVADARE WIFHIN 10OFEET OF BUROMO.I Rp TROTNI E I"OA,MANY <br /> bp9w6 I <br /> MTAt4TNIM WILL l6WF', gEEICCW:E LVMMFRCILL❑ OTHER❑ <br /> NIMIEB OP WASE IANTS:�_NIRAaNI OF lkERBowW:_�NMY01 Of SAHoyF,F: <br /> CNARACTEII pF yJR TO AOEPM OFJFFET: Ge.�/ gimes BOK CHARACTER WATER TABLE OFETH <br /> ttT TAN!/OFtEAS.TRAP ❑ ,,mr.m cMAcm NO.COMWATMEMe <br /> WO 10uTMFNT PLANT O ESSTANCf TO NFARE ST: WELL TWHOATON ApPEI LME <br /> VT STATION O�6liE .Wp E9N <br /> �'�TVF4 of wMp SOR.6NTOR IEARWO6ED SYMN <br /> UACNNO UNE HOIC A"ENOTH OF 11NEe I ' ` DISTANCE TO NEAREST:WEL2_ FM,NDAmN I1F)1 PROPNI MESO' <br /> PITBI BOB 13K1OTN L TH OOETH_�dSTANCE TO MAREST;W4LL FWNOATION PROPERTY LN¢ <br /> NOfN2FD 13W1OTX {FNOTN OE"N -M"--TO HEARVEN WELL INI.ATION ApPEAT"UNE <br /> FFT➢AOE PIT, ❑EEPTH SOE I NUNWEq� d6TANCE TO NFAREAT:N'EAlfOUNOAm. ApwRY yNf <br /> awM 9JFAOTH�_LLNpTNDFPTNd`TANOE TO HEAPS":wEu In(�+ wuwATON f��NpiE1LTV LUNE S6' <br /> gmmmNus ❑WIpTN LENOTI DEpTH��DIRAMCETO NEARER:WAL iO1WpATpH MOISFK LINE <br /> 1 NF1OYCEIBiFY TXT NAK pRPAPID TIOBAfR1CTpN.Wp THAT THE YAH(VNLL SEWHiWKCOpNICf WTTH SAN NAWM COUNTYOM.APCESINDSTATE LAW`•ANDft— <br /> us <br /> AND 1SOULAipNB Oi TXF BAN JOAOVINCDUNT',1pMEOWNEROR1fCENfifD/.OENT•8 bONATUgECERTOIEBTXE wU.ON'IM:•I<fRTWTNAT MTNEPERFORMNICf OFTNF Wp1EttOgyABCN <br /> TIN`PEIM(T K ISWE0.I WALL NOT FMROV ANY RTCpN IN BVCN A MNgER AB TO DECOKE SUBJECT TO VAgLMAN'B COMFENSAMN.Am OF CA{XONNA.-WMMCTOWS 1MYN0 OR <br /> SUBCWTM 'M6ONATYRE S`MSTXE fdyOWWO;•i"`TD THAT N THE KOOTWAM,E OF THE MAK FOR WHICH THIS Ri41R IB IPotIED,l WNL fM0.0YpfN]NS SUB.IECT i0 <br /> OPAN9MMAN'6 CgAPfNBATBTII LAW`/SOF<jAINOggA,• THIS APAICANT NWT CALL N IMW IN ADVANC!FOR ALL SOW,I WNILTpIN, COAW.I SHALL <br /> EWp RELOW, <br /> `ONTO%_ •fM,LF/�^ TITM c /L .dL.� DATE: <br /> ROT FLAN BWAW TO 6CNEI`CRIT <br /> 1.WTME O STHEET8 PA Ty. MEWEM SPOOR BWNOPT T R,,,,O RTY, to <br /> IACATON Of INNFSE SflVAOE dSPoBLL BY6IM OR H SEO <br /> 2.OVTUNE OF THE i'Mi£pry•WTTFI dMFN6FJNB N1O NORTH OWE<ipN. .P.O.OF`EWME ONNO."STFMB. <br /> • O OMFNppMFD OVTUNFB AMI LOCATpN OF N1 EpBTNp AFq]PFpPp6FD BTRIKTINEB... {[� QCATpN OPXELLB 4N I=MMUB ON dIE NMpED FIFTY FT.ON <br /> tlKLwlxa cpvum N¢+e sucXM 11==AAAAK,—a- PAYMEI`BI�`iXOilgn pR AnJdXHIO mOftRry <br /> JAN 2 2 ZGG1 <br /> 5 <br /> PUBLIC CAO.,H. RIINN <br /> 9 aLiH SERVICES <br /> cN�gfnCFlpH'1651L'S .. ... . .:..... <br /> _ O <br /> 00 _ m <br /> 15_U�= 8 <br /> N <br /> iF WR ppMTMpT UBE ONLY �•���� <br /> AL9LKATON MCEVTED BY •I INmIA�,��- DATE: Al, ✓SP1 <br /> TNA•NTOg6U4pIN6F4CT.,BY DATE / / FMN IN6RCIlON BY PATE / <br /> MDTTNNAL MNA ENT`: <br /> • MCOUNTINO ONLY: NOR FK! <br /> R COOS FQUYO AMOUNT RO.BTTFO CNK AW yEp BY OTO WIP6pNTNILWP TNYdCII <br />