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FACILITY INFORMATION <br />Business Name:Vf'�l <br />Owner/Operator Name: f ",kc . <br />Street Address: jg6o <br />City: Zip Code: <br />Mailing Address: <br />Phone Number: ( 1 <br />APPLICANTJCONTRACTOR <br />RE <br />Street Address: 11 5-7 N • M1?� v aL /_.- <br />City: �,s.Lyn�l Zip Code: <br />Phone Number: ( 707) -7&-5—/Lofoc� <br />Contractor's License Number: Class <br />Certificate of Worker's Compensation Insurance on file with PHS/EHD? YES NO <br />UST SYSTEM BLUEPRINT LNFOR2MATION <br />1. Four complete sets of plans (specification sheets and/or equipment <br />brochures if not on file). <br />2. _ Plans drawn to scale in non -erasable blue print. <br />3. _4 Plot plan to show location and number of tanks. <br />3 <br />