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�. SAN JOAN -TIN COUNTY PUBLIC HEALTH F—RVICES
<br /> P O Box 388 V SroC rON, CA 95201-0385 • Pnom�- 9 468-3470
<br /> ERNEsT M. FUIIMOTO, M.D., M.P.H., ACTING HEALTH OFFICER
<br /> DONNA HERAN, R.E.H.S., DIRECTOR, ENVIRONMENTAL HEALTH DIVISION
<br /> ENVM0NWNTAL HEALTH
<br /> L-WE3tATING P IT FOR tA+ ERGR L4 D ST-f zz.F W r,], , T-y
<br /> Tark Tank ?eriit Annual Per*lit Fe B Vah.!
<br /> p;� r tr, ? k n r y n-„- *_ eT i '`# trs r T-
<br /> Nuahe. Re_.rd _D mt+e. Capa,it, �v..4en.. r si a a i rA
<br /> '24) 001 Tn1?7t�1 (;flA�siS t.J•.:•,?7 ,:n =ea••: !� !?! n�t1Ve l4eTffi2. !)11'11(''5 •c(.'ii(95
<br /> _._c 01)'- tA1972U� 04512 10,'Jl !'nle ded 0; Active L+Frn t. ; 01/?5 12!31(45
<br /> tlf�t4f j �:rAr+J k'� j lr�+CAI�I '-°tii1,1,: Geral}.
<br /> PERMIT CFONDITIONS:
<br /> oreiT T� {pck�'c kill eccbe void it cN�'tt� ?ER1"iT ,ees and : MICE ?es are rwlt aid arj'{,r t.ha fnT systwo(s tai's
<br /> i4 *c%aln in c^q'F,r'ilance wain the PERMIT cc!M}I?lw,
<br /> -he bSMJT TO TTBATE is granted t4 the TAIa'K CMCK who accepts res.pOrCtIlity, fc.r opefalir aT:]
<br /> sCCor4tn•7 t4 State unjerlroliri str:rare ta!* laws aPd '✓Mu.s...:rs as 'sseil a5 any c41YIlt1+?n5 aefby `:an icyqiln fnlir'.j+.
<br /> f9FG Ti 1s1 if dif; r r }�� f-r ncn r�,:ar i if�r he T v _r ,+m
<br /> _. �',{ :, fire L 1, 73 a ank ok.._. _ _i _ ste and _"omit _I l3 s:st E!A a_rording i=' ,-he !4R1l T14
<br /> CFER?_,, S '1CR"_EmEN1T r9^I lrsj UNer "�ecti_4r 2523::. C!'eater Di' iGiC•n �: California alth a:x "at et” ' lig
<br /> The �9tiK
<br /> _W145, siwll notify the trViromentai Health Clivision of any prcFose4 char^e in operation or ,re.,, ip 4f the t'ST
<br /> =.cr any change in eruiFFiert, 4es-an nr oWai1Qn 41 this facility, the PERM TO II.P'Fcu EL wi:: b? *eV 1 e by the
<br /> :rrt-Cimental !ealth Division.
<br /> b Arens?.r'JCt.24n or rc'fd1]Yei eei'ii12'.. 19 +'?'',Ulre6 ;r019 the 'gealt.h Division arior to arly '-s val or
<br /> change of UST systere ern:i W11..
<br /> itY:s ?ER11- TO i_!P '.."y',E _;±all 'M L•= _Oirsi:er_+' persissi ' t.7 'Y:t:lafp any existing 1a1t5, oPd r.r:r or staLUteS 4l G'„'tter
<br /> fereral, state or I?Cat agencies.
<br /> PUNIII in ORFAIE an i17T G'''I' T?� t'.': IN
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<br /> 4.c,:i / 1ssi:Ed -. �y by{. ILfj _�4'v '-CLIVI.�it D 1.�T
<br /> 7 49 H Ar
<br /> _T_lI_ ;Tclra, C:A _S0'7
<br /> PERMITS TO OPERATE and ANNUAL PERMIT FEE PAYMENTS are NOT TRANSFERABLE
<br /> and may t{e SUSPENDED or REVOKED for cause.
<br /> THIS FCS HMT RE 01%_5x_c1YQ 04 THE PREMISES
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<br /> ._�I{..� _ N tlw—rr!;va : iUr ,�. ,hrav ACta4l1!t l: ti(;tj:==: :
<br /> 6749 1 .4-APRT`giIRG {,?f `ac2iit,y in, rll r7 797
<br /> T0CK.TnN . C- 55207
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<br /> �IYJ �IiL ,Cvv:
<br /> •�?::":'T:DN
<br /> 674.3 HARRISE'VF"4 'r'_
<br /> Tia-V Tl_';y . :._a7
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