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8-25-1998 3:58PM FROM P-2 <br />SERVICE REQUEST <br />Type of Business or Property <br />FAC1LffY 10 # SERVICE REQUEST # <br />gfto1 <br />OWNER I OPERATOR <br />Ba1JXG P><R"X <br />FActt1rY N �� Pr a <br />60 ," <br />arra= AOOR> sC <br />�j • <br />�.f 2 <br />l <br />/✓%ati,�- S f 7� an -e"2 <br />,�. <br />su. s <br />MaiAng Address (if Different from Site Address) <br />crn 1�GTGi GL <br />P.o _ 60X oo . <br />IIP C74- 7�4- <br />CITY <br />A-+-` RO�w�.o n <br />/� <br />STATE( fA . � C7¢ 5CJQ 5 <br />PHONE #1 <br />t925) g�2_ gooz <br />AP N I <br />Zig- <br />LAM UsE APPLICATION 9 <br />PMME 92 err: <br />GGS DMT=T <br />LOCATM Couc.. <br />CONTRACTOR I SERVICE REQUEST OK <br />REopesroR � <br />Bn.IXG PAM a <br />BUSNESS NAME <br />VIAL- �hc. <br />COMMEPW <br />��•s��`� � ���� 1200` <br />PHONE.# <br />70 <br />Exr <br />76S - 660 XZ4o <br />MA"4 Aon Y/ j� / / <br />/ o l/O w G l 8 � VGr <br />FAX S <br />7o7 <br />76 S- 0 <br />crn 1�GTGi GL <br />STATE CA. <br />IIP C74- 7�4- <br />81WNG ACXN 1NEEDG>✓MENT_ t the undersigned ProPeRy Or business owner, operator or aultwriad agent of szmsW admowted9e t Ot al 33 ' arxfAor P:ojed spetSc <br />PueLr HEALTH SEMS E VXw,.GnAL HEALTH Wmcom houdy dmm- assoastad with.tis prOlett a Oct%* vM be bled b MG or my buskmn 27 identified On IM ANM <br />I alio c&dfy that I have prepared ibis eppfimdon and that the wceA to w3 be done in ==darxs with Jd SAN JOAaUM COLD TY 00*W oa Coeac Sbndarck STATE and <br />FEOEltAL laws. <br />APPLICANT SIGNATURE: OATS <br />PROPERTY I &>SNM owgM a OPERATOR I MANAGER a t1rl+sl AIrrI+oR� Amrr �"� <br />dA�ucwranoCfie�iL"�P�Dr�davflvtaQe.br+g�tis rill. �— <br />AUTHORIZATION TO RELEASE MPRMOW. When Opplir2W L the owner a operator of the Prop.Ry boated at ttm above site address. Barnby a the reiesse of <br />any and a1 msutm geoWhniml data arxifa enftDMrlente assamment s bu:aboA m tte SM JOAQ W C01M PUBLE HEALTH Smvco EtvW50a NtAL HEALTH OMMM as soon <br />am at ttw same fine tis orovided b ma Or an represenfatVe. l <br />TYPE OF SERB CE REMM S= <br />COMMEPW <br />��•s��`� � ���� 1200` <br />3 00 <br />PAYMENT <br />SEP 11 1999 <br />SAN JyAQUIN COUNTY <br />PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL. HEALTH <br />DIVtsjor, <br />bm*Eaoies SIGNATURE <br />CowrRAcroa'S SIGRATURE: <br />APPRovEo ar: <br />Ewt L -Y--1: <br />DATE_' <br />' <br />AssiGNEoTO: <br />EMLOYEEfi' <br />Date Serrica Co TleW of abeady camp)- <br />`PIE: <br />Fte AnwUnt: <br />id Z,3 <br />Payment Type <br />&leo' <br />Ji <br />