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. rc11ERAL 7RCGZ/Ut FILE <br /> Neo Charge Edit IPRCG37 revised 5/21!43 <br /> FACIL lTT IO 3 I /; I i, CEJ FACILITY NATE <br /> AEC= 10 s /�� L-, ✓ PRlat <br /> _ OAI AY: Ctade A are, a N!lk Oifpar.r __ Neer of Cm[ainers In ✓tuft(-44.d Unit <br /> gob!is Food Proiuza Stand _ Ice ?fan[ <br /> FtXO: Restaurant Narkat CO°alss'ry _Nark,t .!Food Prep: T / A <br /> Saat!rg Uoacdty Sq Ft <br /> tad Food Event yerdirg Aathitaes lumber of 7tading Unfts <br /> TeaoararY Food Faallity _ SPK -- <br /> Food 'fehlcle _ Askt License J1 xegis"Ciont Calor <br /> i <br /> _ .4AZAR➢CUS vASTE: Tan GeneratedfYr TIERD• PENIT F+ ill ty : CA _ CS _ 79A <br /> _ 4a1S(NC: AacalMatel Na- of !hits lall/Ezemc Institution Acusirq Abetment <br /> Esplayea Ro=Irq _-XO- of a`D(myee•.+ Approx Oates of Oe--cw-y to <br /> CJasi"L TOileta Na- Package Tx Plant <br /> _ L1aU10 'uSTE: P'sCer 7ah lel. pumper Yard --- <br /> 'TASTE: Primary Ura <br /> Acute Car, Skilled Atx'sim _ Lg G arstor _ Ss Ce racar <br /> Storage C2-IC7 __ <br /> Storage 01-'al __ Stara9e C ✓iO ) _, Transfer Sea ltd 'Asular 'let CL inia <br /> _ REC3EALiCNAI AEALiNt Taal/Sao <br /> Nurber of Mals Out of Servdcv Pool _ Aatur3L 330ing Place <br /> / <br /> // SIT-c AITICATICH: Emiron Assess ZUST/CLP Loc '4ax 'lau[e _ Rax Nat PPI <br /> Other _eAgteSita � Aar/: x1AC3 -- OTSC � PI Site _ x81'. � _ at.-ler <br /> SOLID 'TASTE: '_Ardf ILL �_ iranstar Its — Recyc(Inq Fac — 'lase, Storage F. AO 'Jate/EAt C Site <br /> Du bazar Na- Svtim.ry Csc.ctar Sd:: __ <br /> g.i 7eh icla Na- -- <br /> 'rECCR C29TR0.: Multry Fan _ Xax 4aaber of lirda <br /> ry L <br /> -- OAT NI .IT <br /> E,1EdCEHCT NCTi FIU71CH for this FACILITT arallor OROUA1t <br /> rarracT t <br /> : ^1 E R D l2QL1 q")) - Ji�-) c_I <br /> CCHTACT 2 <br /> OESIGHATEO -2TLOTEc 1 71VI PRCQAN ?LEXE3LT R Z%�'� I 7YT STAiIS I __ <br /> 1 OF ldMliS : <br /> EPA 10 f• UtSr'frtl7t G77E — L' <br /> a1lL1NG rd C7"Pt-lAPIG AC:.aWLEDQ2ITT: 1, '11a undersigned ovaer', operator or ,gen[ of saw. acir Cadge rho[ all mita rad/er <br /> ;sleet wd C3e PA7/E}IO hourly _+taffies aawelated of th Mia fseitIty or activity ALL ba billed . the p.rry IGrtei(led <br /> 3(LLlHC Put TT on this torr_ I also nrtify thea I here rroervd this aeolloclan and that Jae va-Y to be per!araed oflL IN �k <br /> in accardaraca with all a'mp (cable SAH pl r!1 Codes rd/gr Siarderds and Su[t ard/a' FedaraL la+a_ <br /> APPLICANT'S SICIATIAE <br /> Titie: Oe[,: <br /> e�(,LLFTAORIZArla TO RE_iFatF ULft9/NTSCA: in additlon to dte ,bare, railer agpo m <br /> e, C, oarnrr, entor or agertC of aaara• 'f. <br /> die prmertY lae�ted at Me abova alts address hereby arthcrizt Me ril,aa of any and "L ro CtS, or <br /> aeovevhdol dais rdl <br /> emirm tad/sit* assassaent Infarction is SAH ;CA [X C38TTT PU2LIC 3F}LTA SeTlIC:1 EWIStCaME:NTAL AEALT�a OI'fISId as man a: <br /> It Is arailabi, and at dna sae+ tltsa !t Is provided to > or ay esre¢'r mtive- <br /> Fes Amtsat Aa t P <br /> Data of Payam Pt1•alartt TYPO xaea ipt t neck ! x'c'� °f <br /> aE4S � . ----- _�—I <br /> 5L7y _f—�_IAt .- —!�•I Uxl, 'CpC I :. ��1_ - <br />