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Business Name: She I IyD N IA E -T <br />Owner/Operator Name • 5 �-77-LL G t L.. - <br />F'rc:d l <br />Street ddress: 2 32o AJ ° ( D(5 Pb0 <br />City: STCk,To ►V Zip Code: `T5 Z <br />Mailing Address: <br />Phone Number: ( Zc`:() 9 g 3` i� 1 <br />APPLICANT/CONTRACTOR <br />Name: <br />Street Address: <br />City: <br />Phone Number: <br />Zip Code: <br />Contractor's License Number: Class <br />Certificate of Worker's Compensation Insurance on file with PHS/EHD? YES NO <br />L 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. Plot plan to show location and number of tanks. <br />3 <br />