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MJJAL, PNotBAM FILE 1 Kort -- eal% <br /> !il>`1L1T7< IA 1f rtc[tfttr IGIfR <br /> RECM ID PRION IMPSJIP t <br /> oA€RT: Grade A &600 3 �.� 11111 Lk llispensar — Mudear Containers in iWtti-166 l€niit <br /> ppQD: Restaureflt Market commissary _ y_ Mabl l I Foad _ Produce- tw-d €00 Pant <br /> Sestln2 Capacity — '3d Ft . — -- llarklt tV 1&W Prep; T / M <br /> Temporary Food Feel Lity+,,,w sp+clal food EVent_ yowl lhchin s Mweber of vending Units <br /> food Vehicte Make Licams 9 Registration # I Color �_.�,...._ <br /> NAIIARDOUIS WASTE; Two Gat eratod/Tr �^ TIEW PERMIT Foci U ty CA _ l6 — PBR — <br /> MOUSING., Notal/liatel — No. of Linos jai In*titution Mousing Abat@MW4 <br /> CTLoyoO RoAlm .. _ No. of EVISINM —..... Approx 06CM of 0100*e1Vy /— to �.1...—./�.. <br /> _-LIQUTA WASTE: Purr Vehfole Pu:per Yard _�. Ctyeniael Ta# Ota �. No. ,_� _ Psekage Tx Plant <br /> FEDICAL WAM; PrimarY Core Acute Care ,R^ Skilled Nursing L9 Ma rator br Cv*rator <br /> 9terrmse C2-107 _ Storage (ti-54) _ Storage i k-SQ I Transfer Sta Ltd neuter _ vet Clinic <br /> RECREATIONAL KEALTK: pact/Sp Rudw of FWLs �..,� of Service Pool — I1014r#L Bathing Pteee <br /> SITE IIITIGATiOM: Envi ran AssessUSTICAP _ LW Ra* Vag.te Kai Mat PPL <br /> Other Lead Agarcy Site kyl MCI DTSC , MP3. Iiia _ . Aslan a „-..- tither <br /> SOLID WAVE: Lordfill Transfor Sts . ilea jIn{f FIC Waste Storage For � AS W=te/Exaapt Bit* <br /> 911 VahicLe . Ma. �, Dvopeter „-�..,� 9 ftmtfamry Cogxr-tor Site <br /> VEvTOR CONTROL: Poultry Form_ Mm Mltftr of Vrels <br /> 04 EMERGENCY NOTIFICATION for this FACILITY WW*r PROGUX DAY KiGk1T <br /> COVACT tC.�..it�,..�Z <br /> �F <br /> CONTACT 2 : 40---U- 0Ch—T, C' r` ` "Q�� �.:.=i..I -• .� ..—' E_""� ''"'"""".-..r <br /> OESI5WITED EMPLOYEE S PROGRAM ELRMEMT R C13R1lE11T iTAtII6 <br /> S OF UNITS : EPA 10 it: IMSPECTIDM i E "' , <br /> diillieG =c~". r.i�tF�Ti.'!C: Ar�mt.e+G!>eESY.:.,,Ft".the undersig ed obeyer, 9p*Iator or agent of soft, acknowledge that Ali site and/or } <br /> ,� <br /> project specif[a PMS/ENG hW ly charges associated with this fatility r actlVity will be bitted o th■ pirtY i3entffiid ilTthe�" <br /> BELLING AARTy an %leis fors. I oiso cartify that I have prepared this pplioation And that the work to ko ptrformed Mill lye d4ona`� <br /> in accordance with ail applicable IAM jOMIM C[UD[TT OrdirwiftS Codes or Stmndards and State and/or Federat take. <br /> / L � lM <br /> APKIC"Y+S SIGMTURE �R4"�""'" - c• r+— + <br /> Title: C G Data <br /> AUsuoRIZATIGN TC RELEASE IMF00ATION; in addition to the above. when apptinble, i, thif Wwr, oporstor or m*nt of Saxia, of <br /> the property Located at the abwe site addresd heretri authorize the tabog of WV mrdLt results, gootetnnicaL data and/orrnivirormnteal/Site saseasetn[ InformationtoSAl14m=111Cx�U1fTY MALg"I.TM SggVICF5 EKYIA01a1EMTAL KEALTH DIVISION as facet as <br /> it is availsbla end at the sees time it is provided to we er NY POP I 6enUtIvs- <br /> tem AmountAmount Paid Date of Parent payment type Aeceipt / check S RMW sy <br /> I <br /> RsEKs SUPV .�� !� ACCT ..�,!_.�..�.... UNIT CLIC <br /> Z O d _ 3 I-"I t/ ;D O 9 O T V 6 O E '6 O <br /> `- <br />