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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN•JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 388,466 N,SAN JOAQUIN ST,STOCKTON,CA 96201-0308 <br /> (209)4683420 <br /> • 110"EFUNOARLE PERMIT EMPIRES 1 YEAR FROM GATE ISSUED <br /> M9ICATON Ie NFRFBV MF➢E TO THEeµJOAWWCOUN}Y fOpAI£ (COMPloo In AMR TO CONAVRACTµDDDR WAIAL THE MAN MACpNED, TNI.'"THIN AMADE N COMPLIANCE WITH&W <br /> iFeW <br /> JOAOIxN COLNTYOEVELO —TTJTVM C'N1AFFEMINI110`.3 AND T1H1ECTAH.MOO OFSAN AAWINCOUNTV%PHIL HEALTX��BF''p/VILEB,ENVIIONMEHTAL NGLLTN pMSNIH. <br /> JoO AODPE66rop AMS, I O 1")y 1 {= ITw1 r1�D 11 cm I�`JLO)0/1 LOT WZE���PjgQL <br /> ONMEFB NANE Qz Pal 4 F4(.2 r, IOCAE.6 l IQ(p(a . —Z CJ JAI <br /> CONrpacrop I(1/� ICL LiA lltf AprnEes �� iAnX r SO IxA luj] C`L NgNE' .-/77 1 <br /> SUBCONTRACTOR ADDRESS 11CI RIOHE <br /> TIME OF B C WORK; NEW INETAWTON❑ ApMVADpTON OFf111UCTON❑ <br /> RM SAI EVAIM PERMIRF➢DPUBLIC WEAVER I6 AVAILABLE WITHIN 200 NET OF N11LDNo.1 MARC TRAIN,[IFIRM,ATAw— <br /> MO wMn I <br /> N9TAlLAM1N WILL IDNF: RESSI Pr fgMMFpE1K❑ OTNEp Q <br /> MARDI OF WHO UNTB:�I NLFHEDI p[!FBEMOOML:� xUBBEA pF pPwYiil: <br /> CNAAACTEV-GOHTOADEFTHOF3FFET; _MAO( RTJWAAF SpA CHARACTER WATER TABLE DEPTH <br /> aEPi1C TAN[pNFA6F TRAF ❑TYPDMFO cAPum NO.roLNMTKI(HTe ` <br /> PNB TREATMENT PLANT O CAST.,TO N6M4T: WEu13%FDLwDATwN mnvErtry LINE .0 <br /> PET iTAIbNOI.e,ME TVPE OF PLMIP 6µ H D OSEPARATOR I,NCWB SyVEN, 'C <br /> 1FACM1qNE tlE 'NO.iLFNOTX OF UHE6 LLeI DISTANCE TO NEAREST:WELL Inn' roVNDATroN '.Tl pro4ERV,UNE I D <br /> WTBIEm 13 WIDTH {ENGIN OEPTX��OIBTANCE TO NEAREST:WELL FOUNDATKIN_%tlFEgry UNE <br /> MOLWDDI F❑T,WIDTH IENOTH CENT"_DINARS.TO NEAREST:WELL FOVNOATNIN AOFCMV UNE <br /> TIN <br /> e®ROE RTe p DuVH In WEE LI V k NUMBER!MSTANCETO WAREET:WELLI nT}FpUNDATKIN En�I PROPEgry EYIE 17J <br /> RMMM El 0..IN IFNTTH OEPIN� dgTANCETO FEARE8T:N4t1 FW NOATHNI_fT0fE11lY tNE r C. <br /> OIWEAL PONOe ❑W10iH LENGTH DEPTX��DISTANCE TO I$ME6T:WELL FOUNDATION-MOMM"Yl1E: 4 <br /> NEIGSTCERTIFY THAT I NAVE PREPARED THIS MfLCATAIN AND THAT THE VAq(WEy BE WNE IN ACCOIOMCF WTI 6M JOAOUN E..NVV OFpNANCE3µD STATE UWB,MD WHES <br /> MOgEOUNTroN80FTHESµAAWIN COUNTV.NpMf OWNEq OgUCFHBEO MDR'8910NAT11gE CERiIFIEe TNEFOLLOWINp:ry CERTIfYTNAT INTHEPEN'01NANCF OFTNENtlIKEORWTBCH <br /> THIS FERANT IS ISSUED,I BNALL NOT FFARAy ANY PERSON W.UC.A MANNER AS TO BECOME 6V6JECT TO WOMLMAH'.COMPEN6ATNN LAWS THEME EOIEKA. CONTHARDT6 HRNG OR O <br /> 6UBCOMMCTWO SIGNATURE CERTFE6 THE FOLLdMNO:"CEFTIl THAT W THE FEAFORMANCE OF THE VARA FOR WHICH THAN FERMI IS ISSUED,I RNALL EMRCY FERROM WA IECT TO <br /> WINSMµE COMRRErN/SSATII_OFN LAWS OF CAUFOI�N_IA: In APPUCµT MART CALL 2A FERMS N AIWANCE FOR ALL IMOMMEO LNNCCTIONB. CONI DRAWING BNELY <br /> NSNDATE <br /> ED X V v V K/ lIr F�A/1� TITLE: L�nT�4,(.c 1 r 1 I <br /> y <br /> 0.0T RM'UNMW TO SCALE)6CµE ,e T <br /> 1.NAMES OF 6TIEFTS ON ROARS NEAPEEI TO OR BOUNDING THE PREPE10Y. i.LOCATION OFNpU6E SEWAGE DI6WSK BV <br /> 2.OI Tln OF THE PREFERTY,WITH CSWN NEAS AND FAHVIN DIRECTION. ��M MOPOMD <br /> 3,dMEHLgNFO OUFUNEBµDLCCATpN OF ALL FAINNq AN,Ma,a SEO STAIR• F%PMEpN OF NWAQ.OFOO.6ry.I[AIB NCWDWO COVERED MEAS SUCH AS PATO6,CNE—A- µD WpXS. CI'INE6 6, LOCATION OF WELLS WITHIN MIU <br /> D .OF ONE HUNDRED Miry ON <br /> THE PROPERTY O <br /> ODI ApININO gWERTY. <br /> Rox <br /> s �a{i) <br /> O <br /> JAN 18 1996. <br /> FOR OFIMTMIX}VeE ONLY 41 _: II v AREA: 5` <br /> OATS <br /> APPJCATOH ACCEPIFO BY O <br /> : <br /> TAN(.AT Oq SUMP WSFECIgN DIY NLJE }.M- E� DATE / fNAI INSPECTION BY DATE <br /> MIXIIONALCOMMEMe: P(9L�T0.� LA)1'&AWI -_ <br /> • ACCOUNTING ONLY: NOF IhFAC, <br /> NYi1X- <br /> FE CODE 1.INFO AHED RpgTTR C. A,AEH gECg OY DATE ASS <br /> W VOICE <br /> rrs r 1 � � <br /> 0 os� 3 <br />