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MAR 24 '99 11:18 FR HOLLY SUGAR CORP <br />+-1999 8! 1 1 A FV <br />2098363764 TO 4683433 <br />i <br />SEAVICEMftFcl' <br />P.02102 <br />P 2 <br />cnP�C ncwuof un <br />REWF'STOR <br />SUR44 PAFTY 0 <br />PIMnE0 d+i. <br />NI-amr$ Aftsiss <br />L�` STATE LP <br />SIDING 4CKNOWLEOGEMEM: 1, me undersigned property Or aualnese alallor. 0pa784et ar authopead agent of carne, aunowkdge mat j i iiia endlw wqM s <br />PUBLIC HELLTH SERVICES EK,7FCN ENY^L HEALTH ONISION ho Cie v SS=jMd Wap ASIS Or doh' MC b Bed s <br />� N PfOI� „Y . A d p Pie or Cry easiness as denyEeO on Vis km7. <br />I auo oerory net I have Prepared aes aPplk7aan dna tis Ble Wank 10 CO Performed MB ae dorlp 1A eomNanq wM alt SAN JOAOu <br />I aLW Q %tY f N COUN71' thdbrsNcs Codee. Slanaerds, STAIE ant <br />APPLICANT BICNAtuae: OaIE: (�.y'p— ,LI ryI r� <br />NOPEArY/9USarES4tTvNEA O DPEPATtMlNuzaOEA C71WNAMe7nIdE0ACEtfy <br />/ArtrGerEleptFi pwlv)WrleAildM ro,Ip,I I37.quard E/II• <br />AUNORQA.TION TO RELEASE INFORfA�IOH: When aPptipeie L ft eralir or opentorof rte property iOcaud a1 he above alto ada(eaa, nercby auuanza e1e rNease al <br />any irla 3N RSWS. 9eatEdminl *am and/or MVharl "OvyNa a33eiLnera hip autlon 0 rte %W JO Uw CwNTN PuelK HEAtiN SERVICES C.PON,.ENIAL tWAl IN ON *N of S,0, <br />>s a 4 e.aIw. One at Ole Same taae it o pM ded b M or my r","anpepe- <br />TTpe OF SEFNCE REOUESTEC: <br />COYIIEN7s: <br />AppRONE0 BY7 -. _. ____ E>r/I OyEE X( DAM <br />At41CNE0 i0: aM1M,0TEEri: DALE: <br />Dale Senke Completed {If already completed): SEevIOE COPE: 1 PIE_ <br />Fee Amount: Amount Paid <br />Pdymen{Date <br />Payment Type Invoice 0 Check If <br />Fieceryeal By: <br />MAR 19 '99 08 22 <br />** TOTAL .02 ** <br />