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SAN JOAQU'N COUNTY ENVMONMENTAL HEALTH DEPARTMENT <br />SE1tVICit 2RM11P_CT <br />Type of Batitre at leropetly <br />FACILITY IQ F Puma REWIST dt <br />1S�oo oj-7 <br />OMNI 000Aawtt <br />D <br />CoamtaRot- <br />urscrrst� <br />FaCMMW <br />FAX# <br />"ABD W fI*A4 M F&A <br />44Vb' c.�cfn•� dram y <br />lwar ft W wn�ea* m, tits Adds mi <br />ico t v c �`K p�,ekw�ty <br />yx,o4am coam <br />watt G G <br />ON a <br />W1p WE A►MJ�ATtONt <br />pNessedR ar.. <br />tat ttxra�r <br />locAriou Cone <br />RTote- --- <br />R *cA , <br />.,�.._.. ., . wim <br />� � <br />D <br />CoamtaRot- <br />-64 <br />FAX# <br />a 72— <br />O1tY <br />am t-nrn ♦w...a k— r <br />tip <br />'+ um un==P *d Pr*Pwty er b uis m owaer, operator or suthorkud . spat of smat, <br />soluro+wlodptbet ap elle wAfor proJoot opCI& BKvmoMWMAL HBALTtt DBPARTmamT howdy sharps associated with dsls pto* <br />or WIvIty will be billed to rm or my btuimaa u Wmflw oN this Porth, <br />I afro catity shat I have prgwed this application and that the worts to be performed will ba done in aecordanca wits all SAN JOAQwN <br />COUWY 0*&aaamo Cods, S wm&r&, ltrATa and laDUAL laws. <br />AMJCM"sIGiNA't JJM tr X ') tzhnr'' DATetf-74 <br />,,�Y r! <br />Paoftm/tt ow m*13 Oras wami/MAx"u 13 On= Avrm mm Aarxr p9 _ 6f'+,+nu 4-e <br />6 APPL4W tr *w AeBi4iaMPAW- ~Vp4 '* to s1Pw It ow"I ,ed rit1,� <br />s Who sAPika* [, ft *met or aporator of the property board at dlo <br />above aye oddrora, tsont►y sulMoriYs d o rw oP any UW UI r kdb, pottehnleal data "or envirosunent"te afaegtrsent <br />Wkmmdmtot4 = my d Y &+�At.NEAt ttl DtRMsstt tstrr as soon a it it avadlaW,s end�et�haasuo floss It is <br />Provided <br />TtRaFiiRledtt <br />- <br />D <br />CoamtaRot- <br />AUL 2 2 Nil <br />yx,o4am coam <br />ewwswM� � <br />ossAsrsr <br />HeKn� <br />Ad0lS/E0 <br />it1K0Ytat►i <br />OATS:'? <br />ANsaNtD Toa <br />EM1KOveE P: <br />0•n;: <br />Dab Aarviee 6osnptrbap (Nr aae+y e«nalwrk <br />ditt+nat+Coot: <br />Am Am &mb Asnotmt rtd <br />j L L. t7U raynteTtt nate <br />Nj r r� <br />-� -i,. <br />TV" Invofee P <br />tihoek / $l 3 <br />Reaetwa �y: <br />es+o <br />RKVIND 1111 TWO SR Foul (golden Redd <br />1 <br />