- ' I. 7.,[1,1i,1:7 ,,;,1.,,u_ ,47,.;.1:F.• WITVIrti.I':,,,r1t-.1crv_wc:/
<br />I i ° I A411 2-6'
<br />-i nin! i
<br />piliZ 0.167:1°.' 0 3 1-
<br />
<br />., , LANE) list: APPLicicrioN #
<br />,
<br />..%.iii!1;: ;,i,,ivii ar pHONE99g-3 r 2.1—
<br />_ ok-I2 /1t240 c:rry, sr Art.:1z,, GAZ-7 —
<br />....„,,i:A:. : 01: ..._. _
<br />: ,i171,::' ,.-i-.:)r: Aid ,R1-if-i. , /30x / 47021
<br />
<br />...___ c..,,,,,s.,-ATEizir 32/ 9 4 —
<br />. A
<br />;,.... ,;1.; i 1 ,,,, : ( 0 :k..-..oisisuLTiori 0 1.4-44-Cfr PHomi.: --
<br />L I!', c!., i 1:.v . i; opico5:.;1 II l'Al.1 r A1)01,;175::•• CI-CY/SI A -1-11:/ZIP
<br />Expft R "!1 EAR r: R c.) D NIT
<br />Op___k_
<br />;-;
<br />I !,1, rkp I Y:
<br />7 -2, a 7 ( i‘ItimI3E...ri 32 • Expii;;A;u01,., r...,ArE
<br />OW1,111.P 1')i\ITRAC. inf.; :;1113(:()NTRALFOR/CC-)NSUI.Ti;NT
<br />
<br />lt14---
<br />
<br />! •
<br />111-1 ; • 5/I
<br />Nen Employee ID#
<br />. .1, i•l! 1
<br />MINIMUM .HOUR ADVMJCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 if f /4,
<br />;
<br />Depd-, ft
<br />PerrriT;
<br />\Ai Asi \flER
<br />t—P1 Y ./ 30
<br />2—) Zr
<br />LL 1 -4101v1F PERMIT
<br />DEPArrtiVIENT l88 -AT HAzELTom AVI7BLIF...17'.,TOCI(TONI 9I.:I205 -6232 (200) • •;
<br />i ) Dihrorriochloropropani-'. (4)92.1 Arsenic (4393)
<br />-; • 'I I I •Aeli Kill • • 110.r:Iii:11 I [Viol tit()riix
<br />1111)11,
<br />If •Illf,v111 1.1:111p• WHIR: .:r r.ltitr11.,ur
<br />II -f1-i. ..>111,.,,,,' 1,.h.,11 : 1-:!,-,vInc.c:ri lox)! `,/,/,..11 ' 1 \h/HII‘Iti:Inlioillviralifi, ,,,hoi 1 , I )1bc:r _
<br />n ,,l' boiliirif ' 1,1,1111H1 II t!I '0.4-Mr.') _ . _ _ // "1 `A./(11!. ! !'.311 i 101 int Ir;) , (...r:!(.1i(N:11111,....:11 -4 of 1)orlitor
<br />; till I 11-: ,t-IvIr:f; Vdt711 i ( 1111-f /1.-. wi \ilr.r• 1A.iyil Pi ;i irnAh11 I Cr();,.:,-( :oil! it.:(;11()1i Pt-".p;111
<br />111111 , .. 1 1111111 Pt 1)1;1( Pio 111 .. 1 'HMI , P.-T;iii
<br />ViII'l ! '.•,..);,... 11N il: 1 ION
<br />i',1i0tilOC;>)<Ilit1 1..311;1V , Air krIle'11•V . i\11(1.1' . ,..,I1)1, 1 orli 1 11:11 11 '1)111i
<br />i'F,H ,0:::,1 iilic!! 1-4-11111 _SO) II I -0..,-1,,nliori III flI;IIIK•Ier : ( rpHti 1...;ollow WI mid f-'0LA;/‘ 4.,,,r,p.,:i Di.7.e . irl diarneter
<br />
<br />3r (.or;ing in dininoter - "i (:orultIr.t111 1 ..T;11111 I +(TM II
<br />
<br />'-'•:,::'.! ,•.:.):::ici! I',iiirilni(1. _ _ Ill Ibicl;nef;!:/t..-..itu.le/AI-I I Ivl I::1:11,!1 1 7 -70 ; t'.,1(:,--fl pe:1)1wlic. ' IIIiiinl;;', .'-'iler..-.:1 i Oilier
<br />I. )1,1,111 .,ii , i.,11-.til ,..crileill (9,11/) e.);•icii. to ,lot Idr::ii,,i) )'mci (:.criv-:ni 1..„--)
<br />.__j_i..." J......,...L. sack mix17 gel water
<br />1-...nli will( (:11"X, :iolic.1 .,i 011wr
<br />,.•••.•;‘,.; (,rlf.”1, rli;ic110,-.1...,<1.:tin1h>ed I Firr, Hill nih(A; i f.ii•-larcliiill / Ar.ct-.1(1ralor inLinic))
<br />n1i111 ,1 - ; .
<br />c.;ii,nci,ce Width .0"' II I tAinIll II Tithik in Christy Box ; stove Pipe
<br />ihriu•r,•j1AH.. orInni.• • ; I;•II" Purim II Sl•andirig \Miter Levol ft .... . . .
<br />CERTir,"`f THAT,. HAVE PREPARED THIS APPLIGATiON AND TI-I, AT TIC WORK (Am.:. DE DONE IN ACCOI,iDANC.E WITH SAN
<br />oRDINANcEs. A",',11) i-7cUl-rHSII RtzGl_n_rvi-i(7q).!:-.',. FIFY T03A1 iVIY REQUIRED LICENSE IS
<br />CLIRREF,IT AND .IACTIVE :-•.W.,L'• • STATE BOARF. THAT 1 Atti iN COMPLIANCE WITH ALL
<br />I 35 COMPENSATIOm
<br />t,
<br />11-VM 17414111 00-103LP _
<br />V-ktr g,(s-2--- 6000(7'-
<br />Well ID//
<br />WELL fPI IMP PE RM F
|