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CITY OF siloC "HE <br /> CALIFOWA 9820" E <br /> PbW'CHASE 0 M NUMBER <br /> PH$fig tmi 944.828y OCT 0 a, 1 92 47223 <br /> i� PLEA " PUt tHis idUMBER ON <br /> NOT- <br /> SAN �A I�Il� �, AVOW <br /> ENTAL W 'NvatCe§, SHIf�PtNG RES_ <br /> PUBLIC HEALTH SIIPVIC�S r PACKAGE$ 71Nb Cor:t:Es- <br /> r •NCE. <br /> ` PAM 19OX 260 4 � <br /> ST't CktOM, CA 95241 "Ac <br /> L ~ x igluc15 D�PAMMENt <br /> S <br /> tcjN,eA o�t <br /> IL <br /> .- <br /> YOUR i <br /> L 13E DEDLP:tt[3,1' 47223 9/10/92 <br /> 678--42f I tly0158� <br /> 310,2 25 ISOLICH PLBET PACILIT'Y LOA1 VORD <br /> �555ba ? A; I -, <br /> s . <br /> WAT8R fiPSfiINt3 AND AgLAT IRR SPIRVICIgS <br /> ASSMATHt) WITH IVDU, AI§ANNJXM9NT AT <br /> POLICE V19PARTMgNt <br /> OT TO JgXCLp $500,b <br /> ALL Dict <br /> tOW <br /> NET @ bpi r <br /> P0$00b51 ` �Nr� <br /> CONVIRMINd <br /> I <br /> the A velas 06"md by All <br /> puroh�seRAP or cefitract mutt CONN 1 NOW <br /> conformtie safoty orderg ot` <br /> the state f the-solely Divlsie of d �Of D PLICAT <br /> Indust0a Safety, <br /> . LL <br /> Aw Y P.O.tMAL <br /> $500.00 <br /> the InfOrnol r60mue e6da PrI�U 6 yaU, di ti 8Sn@r o1 godd4 6►l�rvic�l, (4d�urrllsh us $ut ld*pdyfit <br /> IddnNficdNdn hurnbo(TIN).FdIIUFb I9 iuiwlIth TIN tao I6m I in 6#SO.00 p@Rtl1i�►>Yhd Rp oYlFhhaltlln$ <br /> on poymonts. <br /> PLEASE INbICAtf THE FOUOWING IW OOMAtION ON YOUR WVoictt <br /> WHETHER YOUR FIRM 15 A COP"AtlbN, PARTNfRSHIR,OR St)Lt PRO- <br /> PRIETORSHIP. Purtha In QePortment Authorited S14hature <br /> IMPORTANT <br /> -Prepay dafi Vrrr7�` yoa' <br /> '. Qi �• �t� t ,.., ...;�y .,. t: °Q JtRrii{ieW V@ll� rp Ill <br /> 2 nn not 3u6 #iili5 5TI CliT3'dt�diF ttvlFhirf ri alt 1�@livrlp. <br /> e r. C�'h�iY'(f°�'I "tMP��iir61iiTi + <br /> mV7T 1411 Ib't'4i�C:S. <br /> 3-Saie t6j gf'ftb ryW lW" -difToiC i Pt wfi ... <br /> d EXr 5 idk l� PIeNVElRl2L fNi9 t;rtth?rse <br /> Upon re Lr31! a Eti`i�1 - P!i ..,. � <br /> 4 n a m b tI , 8tiR7 b9 vev Will 040 poltri at brigtn artC dzrro-wu <br /> 5 Sui�mir MOirtalilyair� <br /> c.:o <br /> Cityof StbtkiOR, bti"AddSI: .; L't)lgfiPrf :� , . - �+> <br /> FORM<0 0M (IDWI•189) <br />