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03/31/2000 12:11 2095994249 FLYING J PAGE 01 <br />A <br />)3.'2a'�Oi�L"• <br />15- '71 _L�D46' _,a,, FIP''H FLu.R PAGE 13' <br />r <br />SERVICE REC)UEST <br />J SERYIGE REQU ST � <br />_ - F.ACILiTY ID 9 ` n <br />Type of Business or ptopttly � V G <br />Z 3C <br />$ILLING P. RTY' <br />QWhER: iiPER.OTt;R <br />FACILITY NArAtTu <br />Sue ADDREss <br />�� [ StwANwnop• 1.. Do:eion_-- ��..__.__..�..-... 9mr _..�—...�.Trr^_ ----•-aultai - <br />^i1A41ing Address ;re YMtterent from Site Addressl. <br />C ur. I APS 9 <br />PHONk K1 <br />PHONErY2 O"' <br />�rCdNl'RAC70R� <br />REuuesToR^ <br />BUStNRSs NAME <br />STATE d Z ZIP <br />LA -4o use APPLICATION 0 <br />LOCATION CODE <br />rj051}tsrntcr --• <br />PHCNE# <br />FAT# <br />BILLING PARTY <br />Exr_ <br />ZIP <br />CRY STATE -^ <br />BILLING�4I. the �nderwrW property of business Omar, eperater ar authorksO Agent of SMAC, atdtnnwl?dgc Mt V SitC andlor project sped ik <br />PJCUC HeaLTli SEP.V.co EWAONM.�rfAL, hEzAL1H CN:SiC::' t+vuny Cf.arge`r Amodatea with thH Frvject or rlq• vriH he SiIIM a ma ur my buaiaes5 db id9ridtied on tea :tum. <br />I also cortlly that I have oNspamd th s app tos• Auld lhst work tr, crtrtrjd will be dome in ar rordance with an SAN �gAMIN Oww.- Oatrtarne Cedes S11I0derd3. STA, e PJIC <br />FEDERAL, laws. <br />v <br />AaPuC.4NTGIGNAT ........—__..,.,-..--•--„ <br />PaCPE�T f: <br />-S 7- CNrNER 7- -OPERA"GN i MIAGER }� OT1 eq?.U1 rtCR�iE� AGENT - _,-.._. <br />Ir7P�LCANris �ptth 8aurrcP -; pro0l0liltlhaNrstlar tosign is t gw2vd <br />LITH T1 N TO > SE !NFtiRM T1 N: vrhan 9ppacaNe, !• t. a owner or apemtcr of the prop" Iccat9d at the above site addrAoas, I'ereCy aVtt>Cr1ze 7w reteaar of <br />any aml efl ;Bsu!G, reowhnic al data andlor envirynr vf2C:lte assessment mfornaton ,ome $►.N JcAGuw CCLNTY Puauc r°a�?H S_ + Es Ehv1FJF U6�k At FiERL:t+ D"/IS 4N a8 SX") <br />as itis nvailahle and at 1 & same time ;t it orovided tr;:T a at ov re�rssent3tNe• _ _ - <br />� TyPEOFSERVIGER4Y,lUEMO: <br />COMMERTs: <br />APPROW DRY:........ .....� EtdALCY:B I#; V <br />Date Service C ietvd ;0 eady complewdi: <br />Fee Amount: Amount Paid <br />Chea 0 <br />Payment Type . Invoice # <br />10AY <br />MAR 3120 <br />SAN Jt:AQUIN GOUNTY <br />PUB1.10 MI TH GISRVI(yEb <br />-IVNIHONMENTAi_ HEAI-THr I_?UtMl0t <br />DATE' <br />_ <br />SMiCE CODE: PIE' <br />P� sy'msy�ment Date <br />�%-� - Received By: <br />'� < <br />