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S-10-1998 10:27AM FROM P. 3 <br /> SAiT dOAQT7 Y ^..prlAliZ PU3:.IC IMAi.:9 SWMI= <br /> SWIROMMAL HEALTH 8I-ISTION <br /> Siva MIT_IGATZaff NAST&IF= RECORD ECRM <br /> GEERAL PROGRAM 2228: Nev ! range rdlt (PROG4) t`evised 5/ 3/95 <br /> FACiACL'I <br /> 6'�w-' r[J Z' ? b <br /> ZLiTY ID # S• pG1 4 - Vel C. <br /> RECORD PRIOR OIST A PRIOR TWEZPS 4 <br /> itR Micigaeion viyorte:etiesl AssessmentT/CAP Cal YaZardous waste Invest :Flat Pipeline Tavegt <br /> Char Lead 9geac/ Site gor:cy: wQCS DT3C 0 <br /> SPA E ?i. Szte �attcr Q;;alicy Sice Cher :`fie size <br /> 7ESI^.�1Fi—D HZqPLOYSS C iq 7PRCG ti AM EL1TcI� # J 1 D CC Tt=16 STATUS <br /> NU-,M%n OF UNITS 1 l SPA ID d: r—=PEC:ZON Core : <br /> N w.ber of TANXS linked to this ?ROGRAM record : <br /> 32ZLI�G ACC:ostLRDG2.NGIr: r, the undersigned owner. operator or age m. of same, acknowledge char- 4111 site and/or Project specific <br /> ?rfS-EHD hourly charges aaaociatod with :his -'acility or activicv will be billed co the party identified as the BIL;.,L`�G ?ARTY on <br /> :he masterfile Record Information Form. <br /> i also certi.y that 's prepared chis application and :hot the work to be performed will be done in accordance with all SAN <br /> oAQUi:: cOUy1rr Ordinance Codes and Standards, Stateand ceu�eral laws. <br /> AP?LIC:`r'S SIGIDMTU E A - l V'-- t <br /> C,r") <br /> Ticle- Date: �.` `a <br /> lSiidORiAZON TO RELEA.S2. INFORMATION! tit addition to the abowo, when applicable. I, the owner, operator or agent of same, of <br /> the property located at the above site sddraa hereby authorizc the rcie"e of any and all results, geotechnical data and/or <br /> environmental/aitc asseasmenc information to SACT 10AQVIN COMM. 1203LIC MALMt SMVICES E1gVIRR L -IMALTd DrvIS ZCN .ao 30o x as <br /> it is available and at the same Lyne is is provided to nw_ or ray repreeentaefve. <br /> AEIDLMM DAMES: Inspection: Current / / Prior <br /> rse :,mount AmoeuTt ?aid Dace of Pay:nex:t Payment Type Receipt # C::eck # Reck.' ey <br /> Z77 SSS Z <br />