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APPLICATION FOR LIQUID WASTE PERMIT <br /> ' SAN'JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P,O,BOX 383,304 EAST WEBER AVENUE,STOCKTONL CA 95201588 <br /> (209)4885420 <br /> • <br /> 10KREFVNBABLE PIRIUTP EIPISES11W FMN SATE IISL I/,µ',_'J�r' Z V 10_ J> <br /> MIKATN)N IB HEPEBY MADE TOTHEBµJAWMCWNWFORAKRMITTO CONeiRVGTµOppINhow IS tj THE WOpL pEBCMBfp. TXIBA-tt C)�E MCOYRIAJVANBµ <br /> mAWIN COVNtY pEyELOFMEM TER{CNAPIEp 1-1110.3 N1p THE 8'}µ0N,,8 OF B.W"AWM COUNTY PAGM HEALTH BEa RR,ENVXNINMENTµHEALTH DMBpII <br /> me Anobeapa AFNA__LDILL w� Y O.l <br /> /l clrv�,�oT L ( <br /> OKNq'B NAME_k//P4IMA 1%ct S nLDxlg6 S Ny <br /> CONTRACTOR 01"oz - G-S PMdLE &Z�-70 Tt/ <br /> ADDIEee� bcrr o F!1 NN d SS"3:� F L�&�,�si_%roHE}35--FTz <br /> %M COHIMCTOp ��� <br /> LIGC %DIAL <br /> TYII OP/RNC WOaC: NAV VMTAWM.❑ NEpNNA.TG. DFITIWCryON❑ <br /> IND a"M BVBTEM FEINIITTFO N MGM SPAM IS AVAIL.LBIE WITHIN 300 FEET Of eUNDINp.I <br /> RIC TyTpl l 1 NOW MANY <br /> ,.J/ bMdBnx <br /> M/TAUA1pX WNL B6Na: REBIOENCE OTHER <br /> 10 COMMERCIAL O ❑ <br /> xLMBPOFIMND VMT/: XINBil1 OF SFd100M/:� _ -.GNO,ENl.Ep: <br /> CXAFACTEq DF WR TO A OE.OF]FEET: r.-j MMW BOX CNAAACTIM <br /> WATER TAdF DFYTI{ <br /> I" %R TSAR ❑TYfFNAfO CAFI4T' <br /> NO.COMPMTMENTB <br /> FIfOT.NINT 11TATIO.0 11 DISTANCE TO NEAREST! WFLL��_ FOVNOATNIN <br /> WT/TATNIMO 61EE PIb,Mv[ME <br /> ,�,/ TYFf OF%IMP B1Hp pq.SEPARATOR IFNCL06Eo BvrtFM <br /> tIACMND <br /> USA tl ND.B t NOTX OF diCSI,,STANCE TO NEAREST:WELL1 <br /> PETERFOIXIOATpN �iROMM V LMF� <br /> .D.Bm ❑WNTN It1giN OEPTN��DISTANCE TO NEAREST:WELL FOVNDATIW <br /> M0011D® PROPERTY RINE <br /> ❑W10TN IFNONI OERTN��drtNIOE TO HEAREaT:WELL <br /> FOUNDATION PROPERTY NE <br /> /EFFABE%T/ ❑DEPTM NULNER <br /> BIITAA / B� 1 DISTANCE TO NEAREST-WtA WVIIDAIpM IT]1ERTY UM <br /> p/POSY qMO/ �AOTN�_IENOTN—Lp__DFVM�_DISTANCE TO NEAREST:WELL�aLFOdpnTON I�_Pa01CRry UNE SYS/ <br /> ❑VBDTN IENOM OEG7"-DISTANCE TO NEAREST:WELL-FOIMOATON <br /> RORXIV m1E <br /> 1 HEgRv:;:i fV}NAT IUK g1EPARAf TWB AFgO'' , I I i I AT THE W9q(WILL eC COMM <br /> µD 1E01MTWNB OF THE BAN JOAWd COUNTY.4011 __ nCCORD'WCE YARN A'NN'D IN COUNTY OIOINANCEaµDrtATEUWB,AND RULES <br /> TMe <br /> ft'IBIBWEDIWA"NOT EMPLOY ANY KGODH IN NOON A 1ANNERµTO INDNAE CENTURIES <br /> EEN t10 WHERMU COMPCERTEPYNAT OFE REFFORXA.' COF TT . <br /> HE OT RM MPoND pR <br /> BU=M,, CTINOMNATUREC2MFIE8THE FgEOWl1O:'1 CERTIFY THAT IN THE FCWORNFNE OF THEM WMRW H THIS PCMRN IE RWE0,I WIAL FMgOy PEppNB NNECT i0 <br /> WOR(MANY COMFENBA-TjONIAWBO�F�CCAI, -A.-THEA ANT MUSTCAU!1HO"IN,WVN1C!NOR ALL REgSRm RBPWRON/. COAgETE OMWMO SEIOW. <br /> SIGNED2 <br /> TRIS:�'D/LA'IG6JO!" DATE' <br /> 0.0}1(Ai IDMW l0 BCAEI aCAIE 'to <br /> 1.OWUNE OF THEET80Rm. ST.DREBTTO ORaWNpND TNF%OPfRwl <br /> !.OVTUNE OF THE PIO{CpTv,MA{N DIMFMBONBµD NOaTN DIRECTION, A.lDCATON OF IOUBE SEWAGE dM,,Y BVaM ON ROPOem <br /> O.RELMVS..COVERED <br /> IDCATNIHOF ALL dIBFMD ADI ROIpam BIgIKTV1E0 �-¢,-PANBRN OF BAYAOE DGNOBAI SYSTEMA. <br /> • INLIINXNO COvePFD AREAS Wex Ae RATIOS.ESAF VAN.AIDWNXa, PAYM ERL'rAMN OF NCiLB WTTHM FMR.OF ONEXNdIEp 11,FT.ON <br /> MDPFRFY ON ADJOINiND glpRaTy. <br /> JAN 2 2 2001 <br /> SAN JOAC,j!%COI,NN : <br /> PU Ic 14,ALTnsEnmrfs - <br /> _... ENViR3N1E rKiiFAI7N <br /> 00Ali <br /> (Y1 <br /> y� \ <br /> gw <br /> AMMATIONACCEFFEDBY <br /> Y <br /> �/T� NON DIdANTNMT WE ONLY FOR DESANMENT WE BNLY <br /> DATE: ARN <br /> TM%.%TOR 6UMPINBPECTRN BY DATE / <br /> NNA INaRclloH av DATE Q/ <br /> -...LC...ONTO: <br /> • ACCOUNTNODNl, ADI <br /> FACT <br /> FE COBE RE INFO MgVNT p@AITTED CHEC MN V[p AY D TF <br /> ^' MIPEIpVT NIMAOL ENVOIOCA <br />