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APPLICATION FOR UDUID WASTE PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WESER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NOWREFUNBABLE PERMIT EXPIRES I TEAR FROM BATE IRRUEB <br /> IC. I*W In Tryi.1.1 <br /> AIR.Mmx w.TE\v YAoe TO THE T.w»Aoux(mNxrr Rn A rErvAD To.xmw.T ANDmn WerML TxE.von oEsewelD.TNM ATVCATFMw MAOF M wOAEIEANce MTm.A: <br /> JOAdIIM CWNm aEVELDnAe.TIr(E.erwfu Ott ID.a rum TxE erARAlaw oF.AN»,lo�m.lam nI\Ts xeurN.ERYclE exEww.wrM IF.ALTN om.mx. <br /> AM AmnewRARI /0621 leT 99 WEST cnr Lor INEE <br /> DMFA.N.YF CALVAQy eraLE&UQnv ALmR T P-a•BOX 16-03 Lo DI 9 z o , Dx F4-9/10 <br /> EDXT.cTw VALt.Ey6G Xa3r mW AGDIEM P•o, Box 3714 TURzmk UC. BONE 669-/40,3 <br /> Mw CDNEMCFM MOIC6. w10NF <br /> TrrEa.pnc Wo.: NEw nprAwnox❑ IOAn.m.ww❑ DFnMw:now 0 <br /> 1.REFI.EYBrw FORMTT .AIHIC RWf111./NMMIE MTWN Nm FEETOfeWANO.I RIC Tp1N111NDW MMIY <br /> Aw.sMn I <br /> MEI:lW1wN RRU mlM14: RE.E.F 0 CO...L O OTHER❑ <br /> IIIMPpVNrM Uwi.: MUTAFN CR RFCROOIW: .001101PIOY®: <br /> CNMUICTER OF WR TO A OEFIN OF O FEET: FTMEMP ECIL CHMWCTM_WATER TASl CTFFF <br /> .FMCTI1MIpIpfE. 11 CMACFIY HO.COMPAnIEdTN <br /> IRO TREATMFNT ATARI 13 ..T..TO NEAREST: VA1 FOUNDATION FRF9RY IIIf <br /> LIFT ET..0 M2E TYPE.1.1 .HE'D Ol EEFMATOn IpIC .RYEfFn11 <br /> lEA[MXO WE ❑ MO.\tENOTM OF IMEB pmM1MCI IO NENRBI:WILL FOWOATON� IEIRY <br /> HTTER e® 0 NATII LWATN IRPTH�-NTFNmE TO N ULRUET:M£LL FdmOATTON�FREFEwTT IME <br /> MOIMDED ❑WmTH IENOTI DEPM _WlfA fTO NENIEn:W FOUNOATEON_PROPERTY OF <br /> .mAO!wt. 0 CETII @E NUMBER EOFF.E TO 14MR:HELL_EOUNOATXR__PROPERTY WE <br /> .wn 0HMTH IINOTH UERTN�OITAMLE TO NEARETT:V.OL WIMOATOH_ROMRFf IME <br /> OI.A.LL EMT. OxTOTH us, OEFTH�merlKE10 NEARER:MEII��.WIOAIFM�wbRMY11NE <br /> I INRTY CIATFY THAT I HAW PREPARED TFS/ ATRIA ANO THAT THE Y W MILL BE GONE M ACCOrORMCE HIER TAN A)AO MCOUMY OIOMVCE.IAD FFAT F UWP,ANO RWET <br /> A w:OUTATION.EH,THE sAI bMVN COOMTV.HORF OMNIN ORICON MD AOENFY TOIMTIIIE C M OR.THE MUEANm:1 C ER THAT M THE RMdM ANLE OF THE WOIY.TOAlN M <br /> TNY F9FIn M..,T.NOEFWIOY ANY FOFCN IFTIICNA M.A.TO EECOTE.. FT TO MOw.F.....RAW.OF CALF I' ...�TOAT.XRTN]OA <br /> .IwLOMTACfM.MATURI CERfO1E. EFOLL FRIT QIRRY THAT N THE REOpEASF OF THE W R(MR YMICN TM.FEIMR w PRINTED.I REEL IM0.0Y PER .TVTJECl TO <br /> W01RMAf.COYqa MN U'M OE IIA' TM!AIPYCNI!MUST CML IA MW M AW.. 1✓�.WREEFRON.. CORNPE pNIMNO EE1pW. <br /> AFT R�L TRE. D DATE: 2.11 19 P3 <br /> 0.0T I mMW TO..CM!_ '6 /v <br /> I.MATEE OF RRTSORRAOt HEARER TOORTpI THE ROPdTY. NO 06440 O4.......I TOOK FiWMEpWTM TYTTEM OR FOIYSED <br /> E.OUwITE OF TE RMMFET.WTX OIFEMTIONT NIO NORfM EVEwION. EAE'..OF TEWAM der9TM TY.fEMT. <br /> 1 pMEREMNM OVNNF.ANO LOCATION OE ML.1...TORBEO RIFA:TWF% f.IOOTTI[1X OF WELI MTIMX RM:/T Of O.HUMORED FRAY FF.OH <br /> ECUOEO wOYH®ATEA.UCN rJ FATOC DIMWATIL ARWMNT. THE PREHRTVOR A61dNMO FREFLFEEFFpFF pppp p <br /> PMYFMENT c <br /> WTIIIF <br /> PF� <br /> -00 a A I DEC 1 <br /> \ ��p SAN JOAQUIN COUNTY <br /> �.S RALf4W NOUS N 1 - <br /> PUBLIC FALT <br /> F NtlBERVEOE9 ... n <br /> EIMRC1NLTfNTPLNPJILTH ONreWN .--Y <br /> Wtb� <br /> Ogg wtlNe �ZIVE2 <br /> AAT.ATON ACCEPTED By LiE♦ 1 py y,t�(MwME1T VEONLY wle: I I lAIEA• Lc <br /> �� vcV� <br /> ��—"`xxx111 <br /> TAM.RT oR wuP..FECTON Tv GATT / ENML MT RIFF <br /> AOFAT.A cOLWFMFs: N <br /> AccoDNTmT onT: ERCT <br /> Fa NMD c.cu A RpOvm.. FNF..r wlrn <br /> PLO.HRWM Snrv.-E-0 1]613.96) <br />