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<br /> MI-lew 1[-I at E: isiiurt=r!cility ---___- ❑flc,.EFH I''rcpmm ar'Id NIC-Is 1.1citity
<br /> A I
<br /> ----P I ilgram Record iy
<br /> ]l�aciIif yr ��sc)c. E'��
<br /> (['lease Cllecl:the appropniaic descrip(i In and specify:St_ nuniltet`Of unit and Lici-finM( Inforrrl'a(tOn-)
<br /> FOOD PROGRAI%i(1600)
<br /> ® 1_-,CSi3uran(: FJ
<br /> Capacity Square footage k O0d 9�azld[CTS COLIrSc)CCgUiFCCI: i'ES U f`o
<br /> El ?of mmissa E)!y StO[agc Only 15'Ith Food 'rep`:13fton ❑`readia ('tf acl,i,es-11 Umber 0f UniLs_
<br /> ❑ rtctail Market—Squarc.lootsge ❑ rs'idli Meat-Markt only ❑ 1-fultiple L)ep:ufnu_nts ❑ I'repacksgcd Good>Only
<br /> ❑ Mobile Food Vekiclrt —i',i,rjce Vehicle TJ-pc Color
<br /> Reri-traiion 4 L.icCnSC i; Stici:er I
<br /> ❑ -Mobile Food Prep Unit-Make. Vehicle Tyle Color
<br /> P.egisintion r' Licens,~r Sticice,-r'l
<br /> ❑ Temporary L,00d Facility---bates of operation from io ❑ fte.I'1ar_f
<br /> ❑ Special Eyenf --Date-s o`operation fro rt-, iu ❑ I'rod!;ce Stsod
<br /> DAfr-{V PrcOGPj N.1 (2000)
<br /> © 'Grade A Dairy ® Gradei3 I ny vy ❑ P dlz orcontai nrs in MI-I i-I{end Unit
<br /> -
<br /> u-t,P,& ❑ State Facility Surcharge(2399)
<br /> ILkZAT(DOTES Vf!,STt F PROGI Ahl(2200) !
<br /> Q FI;iLL€-d04.4S `''rite Gen crater-- 'rons Gene=rated Per Year 0 Recycle I L emp(Systc-u (2299
<br /> El CRT 0flsitc 14artdlerz (221.U) 0 Silver Only(2222) El Appli•anc.e Rec),cler,(2217)
<br /> Tic-ml k`^rFt:Ctti Z : 'I 16-H(')' -- E-1 Conditionally_-Aulhorized(CA) 9J CondlttOnall_y tExcmpt(t_L)
<br /> C1 p cnn t-1 y-R;ulu Fj-\c(j-unit ❑ 1'r'! dt-.L3y-1WUle rmo scbold 1 az-,rdoit;W"astc
<br /> ❑ A.-30V.GTROUNiD ST0IRAGIS TANIl FACILIT'n'(A-ST)(2390), 1-1un-J_r of AST
<br /> UNDERGP:OUND STO'R GE TikIlIK(US-Q 1'17fJGPAM(23 00) Lfs,�UST/I and B Jwr Lr
<br /> � �ofeil-torr-1 1_'••iun3Uer of IJnit� L�I .";ai1,ar ,:iErrrpt prstiiutian=--l:�Iuml-�cr of Units_
<br /> ErPtoy,:1COsrsiag(2700) UscEtw,fv iT_.ni,vtCamp pjlriraiarJ=oi�r
<br /> rSITE E+LI s IGATIOH(2900) UNDERGROUND IP19EC T I7N (;0H e R0L(3000)
<br /> C_P Emlrg[lmeufal lt_)-CSsmen I'_ll it_1J-'-i1 C 6' it= F—I )Loco UffiJ Clean Ctp Si(c ❑ I'"ri'L SEE,C.,'1rau'up nice
<br /> ❑ AUaadoned Yltii`Sitc © Site ❑TV,VQCy O'l croup Sifr_
<br /> RECREI-is 6 0 M A L H E A U-f P-I P R 0,G PA M(3 6 0 0)
<br /> NumUcr off'ools/Spas at i?_cili.t} ❑ !i'ao1 ❑ Spa ❑ ' f-I of Sc_v-sic-I'aaUS,�t I_l i't.tura3 Lt^Lriey:,�.rc
<br /> VECTO CONTROL PROGRI-4(4000)
<br /> [1 0 Iieuael
<br /> TA"I YD0 63tDD`if @'IERCH-IG, PERY-.1_4HENT COSNAEf 6+.' P'C'_fJC:dUyJ(4 1011)
<br /> ❑ Tattooing(1121) ❑ Zady1,ic1-4:in.g(41120) ❑ II'enmaucat,Cosmdics(4i122)
<br /> LUOUID WASTE PROtSLCAeA(=1200)
<br /> F1 rumper L iceme,� Capacity :/elliei. --
<br /> ❑ Pumper Ypm ❑ 1,-C.L g e Treatr'rt,:nf 1 I=:Uz- ❑ 't_,lirC�ie"!1 TI1)HI2t` 1`lutil6)ZC of Um L• --
<br /> SOL6D WASTE (':400)
<br /> IL:avdfill ❑ Tr m[,er Shiion CS Ari!Caen.cr/ tifia_te Site ❑ Sludge/Ash; r
<br /> QWzsteTi.re cr_ility ❑ Contpv_t.Faci[iil h_i ['ror_essRec)'ctc �:cilily rr ❑ C61s,A stzdl�li ;_li_
<br /> ® RAIU'sc ir_ldcles-Numbcroi.Units y-t Oufn ;tcr,>M C!!;i CI --Humm Ur unfits t-1 '"i!-rS1/t'v?nCft Clcartj.
<br /> PlEDIGAL',VA ST E t'GZl7GrL1f,1(,4 0)
<br /> . _ D d70] iSn3ryC'ir. F-.] ❑ l 3-_r "cncr^tor J L T^,L
<br /> CI I�rn.astirSl:;tion L� `,'cte:nr�r}'r�6i�i,c �urnr�>o❑ ciiiiy---L_I _ ' i0,--- I� 11 u0 ---❑ '-CIQ f�j�c
<br /> F>_y6LVC v-If%a mss{ _ u E;,9 V,G,GRfl_fv'I
<br /> .C;l-' CiC7 'lt=r1IP9Cr;.i:'Gil Car,
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