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r Applications Will Be Processed When Submitted Propane Completed.as Sure To sh9n The APPNCatl m <br /> APPLICATION <br /> (for Non-Transferable.Retroc&W,and Susperldable) A <br /> ENVIRONMENTAL HEALTH PERMIT <br /> IS <br /> Application Is by made to carry on business In the( �io��are&of 1M^seen,Joaq Local HeAlth Oist►1c - <br /> Business Name(D ) 1 <<� 6� 'it...e�.� Address—K ��— `� - T, <br /> Addre• <br /> Firm Partners.Addresses andTelephoneNumbers <br /> Business Telephone No 31xEmergency Telephone No. <br /> Contractor L"nce NOZ,/� G _ -----•-- —_..--- _. ~ <br /> L Applicants Name(Print) - _-�-LCl t_. _1_ -1I^L�-_-____- Title _ �/�'�4Q Dais =.. -� ` <br /> J `� •C <br /> Nese.clectt Appfieable Cale9ay(1-T)and FIM In the flow ev Inlortlwill �- <br /> 1< 1, O POMPEII VEHICLE PERMIT REGISTRATION(FOR EACH VINIC") J <br /> Disposal S11es <br /> For July 1,_---June 30, 19 __--_ -- <br /> Description(Maka/yr.-Color) - ----- - 1 <br /> - _ CAL LbM1M Rsnawal No -- <br /> k Serial No. CAL.License NO. _— ----_--_ <br /> Capacity-- _-- Gsl.WAlphts d Measures No.. ---- -' <br /> Equipnlont Parking Address <br /> 2. ❑ Ml1MER mho {{r r <br /> AWY <br /> For July I,_____._._ Jun*30 1q <br /> or� <br /> No.of Venrcles Stwwf <br /> No of Chemical Torletr Stored <br /> f <br /> ❑ P <br /> ! ERCOLATION TEST <br /> R .or R.0 E Name R.S.or KCAL Na --- — <br /> 1 Test Locebw <br /> ) <br /> 4.. O fANITATION NZRMtT F <br /> Job tan ._ /li.J�P AdASSrMt -- <br /> owrw c ' �..t..6� <br /> O SEPTIC TANK ❑ "UP001. O LEAC-41N FIELD PAGE NT 0 PACKAGE PLANT <br /> O —juli 1ENT O TEMPORARY ❑ NEW REPAIR O OTHER W <br /> IL 0 CHIN CAL TOILM For July 1.•June 30. 19 C` <br /> Tyv.Oonadtlown_ .. ... . -- owpoe I site 0 <br /> No.d IJrtlls Eou+or++ant$uwsgWCkw*q LoOai <br /> 9,. 0 PACKAGE TREATMENT PLANT Fa.hely I..Jur*30, 19 <br /> WAM9 04f11Md <br /> Now <br /> 1 w <br /> i <br /> PWM Logllon h <br /> PWM _ No y <br /> T. n LA1 SOM For July 1,-June 30. t! <br /> sim ❑ Lana Than 1.000 S0.F1. ❑ More Theft 1.0W 11411, �. <br /> O OW CLEANMW,Chemicals UsediAmoum4 t). . <br /> i that I haw this appkalWn and that tfto Mork wins to dons M accordance,with San Joaquin County <br /> 1 AMeby oen ty tried <br /> ardMenoas.state laws,and rule►agt�ropulatarM Of Loots He&"DMtftt <br /> APPLICAFIT's SIGNATURE X <br /> FOR OEPARIMENT UU ONLY <br /> tfae it om D AwojAtt.r _D Pct t!MT Y O PER am D(tA0/' D 1 a troraee h>r way tt D.L+r+a traee.aa MY^ft st <br /> BILLNG{ CHILICKM <br /> BAK 930 ANATION DAT[ DAI� MtTTt <br /> n[ D A1110Uh/T OMAMOUNT <br /> !Ella <br /> P�rw,ttOKKtAT� <br /> IDA <br /> PEw�tr y ; <br /> y w D.r. <br /> uana •-T�— 's, <br /> -"'�x _aaruaw... COPKs TO lwrwoMrPRAf.IIaALt'N euaalTnatrreea teat L NAiaLTON AVL.P.O.M flea aTOOIrTON.CA assn , <br /> waxes„p.,..r�,JrWn,�.,/y'ac.t•„_. - .. _ .:e,_... <br />