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<br /> U 11 C'01)1`TA"/ -!Ii 01
<br /> I"(tiqL'E !\',E,t-t)1W 1[,'IFOI:MAT I ON F016�I
<br /> L1 Ell Nops:1111 3( L-([-,0aR Facilicy F-11 Pru),T-aril Lail Nni Vaclti(.;
<br /> Rccof.d HL
<br /> E--a5li�Y:t-o —5—� -Ww��-
<br /> IS7 1 C4 0 tw)(0 f 1�
<br /> ,(Tacilily Addr( Fjeno�)-CUTO-e—"
<br /> (Ne--:,C C-1-leck the 2ppropnit"dell
<br /> sc cipiivn- and 11ccify cite, ki U till)2 r or u nii s and porliacill imovill-.26,
<br /> FOOD PROGRAM(I GOO)
<br /> Seating CaF�2C4)'_ S,,ILj-jFe f=ootage 11,0,)d I ill fid 1CrsC.0UF,-.` feqUiVCkj: VES Ll NO El
<br /> ❑ Commissary El Di-y Sk,mge only ❑ v,itli 1-00,1 Preparation E]Veadia,-Al-chiacs -Thil-11ba(A Units
<br /> (
<br /> El Re(ail Market—S,-ivarc footage ❑ with Nlc=at only ❑ Multiple i'fQj-,!cLzbPCd Gllod; D1Y L fI
<br /> El Mobile Food Vcitick-—Make Vckicic T;T` Cc)I,---F
<br /> Regil-urition 4 Llccnsc N Sucher it
<br /> El -Mobile Food Prep Unit-Make Vehicle Typ, Color
<br /> Liccn_c N Sticker t.
<br /> EJ Tempomry Food F:iciho---Dates qf`oFunation from to El Ice viail(
<br /> El SpL-cial E-i-,ea( --Dates o I opzratioo from to El Produce S(:)a d
<br /> DAIRY PROGRAf-A(2000)
<br /> El Cradc A Dairy EJ Grade 3 Dnk Ej Jjjjt-f jsr in
<br /> tN[Li-111-d Unit
<br /> CUPA El State FacRity Surcharge(2399)
<br /> HAZARDOUS WAS9 E!'ROCIZANI(2200)
<br /> E] I 1:17-11-ci.,3us yyaste Generatci PC[Ycar El Recycle/E-remp(S)-s(eni (2299)
<br /> U CRT Of site-14a.rid1(--E-,(2218) El SlIver Only(2222) - El Appliance (2217)
<br /> I XC
<br /> Tier�d Pr
<br /> cmi((inqg 0 C-xidttioaally Audioii-nd(CA) 0 Co 11 J i 60 ED 3 1 1Y E' n Ip tC,
<br /> F-1 Pc=it-By-Rule Fixed Unit L1 Pcm,-U't-By-kulC Uou-schc)ld 11a.z4idms-Wastc
<br /> ID ABUNT GROUND STOITZAG-E, YA!11-- UACILL-f-'Ll'(AST)(2390) 11 u n-k-r or AST
<br /> 1-)tWERGP,0UND STORACE TAA1-,-(IJS)!,-R.0,CB-AM(DOO) Us,c U .-,-A arl.1 3 ro 1-,,
<br /> 1-JOU.3jt1G VROGRAV,j(2!00)
<br /> j jil ir ris(i(i.i(ioa--i lumL.r C[UnifL
<br /> El Hotni!o(-T of Units
<br /> EmptoyL,L Housing(2700) (Is,:J-
<br /> Carap A17plicacioa.Foot
<br /> SITE MITIGATIDN(2900) UNDERGROUND jHJEf-fl(-)11 i.0HTROL(30N)
<br /> ❑ Failronvicuhll Assessrucal ❑ UST-CA-e Si(e El Local MVC-Icauup Sits El NPUSEV Clclnup Site El uTcsi(c
<br /> ❑ Abindoued AIII'Silh- El iloa-HPUSEi, Cleanup Site El awQCB Site El 1.7--ter Quality Rciaicdia(ina Site
<br /> R- ECRPHATIONAL HEALTM PROGRAM(3600)
<br /> Ni,mberorpoolsiSpa-L;at Facility D Po o I El Spa El out ar scn.ce Pr)()USpa D N-..tura D 2 th i n g Arca
<br /> a
<br /> "JECTOR,CONTROL PROGRAM(4000)
<br /> 0 Pou1tQ,Farm—1A,,:cirnum number of birds
<br /> TATTOO U 0 DY P I E R C I I I G, P E RM A t,!E i,17 f-0 5 N1 ET IG F,P,()G RA N1(4 10 0)
<br /> 0 Tafto oing(1 12 1) Cl Body Pier0ag(4 12,0) El rer-Luaneat Cosmetics(4 122)
<br /> LIQUID WASTE PROGR-6,111(1200)
<br /> ❑ u nip er'V&i c1c-R e ci--Lratio n Liccri!:e Capacity Vehicl,-
<br /> ❑ Pumper Pard El V fi!:�n-c Tr c 3 tat,a f.It I an i F-1 C li,-uii c-0 T o i 10 tS TUT117-, or Unit;
<br /> SOLID�IASTE PR-0GRAN't(4400.) .Sludge/51r Site
<br /> VV�,0.e Tire Facili(y El 1"1, V vc,C C s S/-f,?C Q,c t,- Ej C!A3.111,flill Si(c
<br /> JI-N ;, .1, F-1 �--,T-012[10A C[�:Jntlp Sit"
<br /> El oj'UniLs ......
<br /> IMED1 GAL'i'lASTE P
<br /> El Primary C-rC in i,:r-pirod hauler
<br /> 7 F 0 L I G',TAT-1,---R T t--i I t'4iJCdi i,
<br /> —7
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