Laserfiche WebLink
For DISC Uw Only <br /> STANDARDIZED PERMIT NOTIFICATION FOR <br /> Region EXISTING HAZARDOUS WASTE FACE TI'IFS <br /> please refer to the attached Instructions before completing this form. <br /> j Initial Notification ID Revised Notification ❑ <br /> I. FACILITY INFORMATION <br /> ID NUMBER CAD 9 8 2 5 1 0 2 8 1 BOE NUMBER (if available) H HQ__ <br /> NAME (Company or Facility) PAT X-RAY COMPANY, INC. <br /> (DBA—Doing Busimea As) <br /> ADDRESS 711 SAN JUAN AVENUE <br /> CITY STOCKTON CA ZIp95203 - <br /> COUNTY SAN JOAQUIN <br /> LOCATION (Description) LOCATED OFF I-5 OAK STREET EXIT, EXIT RIGHT TO FREMONT <br /> AVENUE, GO DOWN TWO STREETS - 2ND STREET IS SAN JUAN, <br /> (Latitude & Longitude) TURN LEFT - 2ND BUILDING ON RIGHT <br /> CONTACT PERSON LeRoy Donald <br /> (Last Name) (Fuel Name) <br /> TITLE General Manager <br /> TELEPHONE NUMBER2( 09 ) 465 - 3828 <br /> 11. MAILING ADDRESS, IF DIFFERENT: <br /> COMPANY NAME (DBA) SAME AS ABOVE <br /> STREET <br /> CITY STATE _ ZIP - <br /> COUNTRY <br /> (Complete only if not USA) <br /> CONTACT PERSON <br /> (I-Ari Neme) (First Name) <br /> LIM <br /> TELEPHONE NUMBER (_) P't <br /> MAR 3 1 1993 <br /> ENVIRONMENTAL HEALTH <br />� PERMIT/SERVICES u'° <br /> DTSC 1093 (1/93) DRAFT - January 27, 1993 P <br />