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FRIM : MANTECA LIQUOR AND FQ00 FRX N0. : 209 239 4550 •May. 24 2004 09:58AM P1 <br /> 05/24/202)4 09125 205464356E <br /> VC,LUFD EN5IYJEFR.:NG PAS 02 <br /> SAN JOAQtJn'COUNTY ENVIROMAENTAL HFaTTT DEPARTMENT <br /> SERVICE REQUEST <br /> Typo at edalime or Property PACdJTY M]M t T <br /> OWNER!OPERAt aeCKlrasialo Aapwua <br /> e n —. <br /> PAmrrry Re q= o <br /> GDEAD rn tear} }eAo� g5�3�O <br /> HOME or YwUaoAtl01r9as iNDEkrnrl tram dib Addnaa} <br /> Gm WTATE LP <br /> Prlorail DrtAPR# t.AVOUaE pPOucJlnOxi <br /> qn, cos We++eer """IN Copt <br /> PiIpEE2 X475"2-4p 1 q <br /> CONTRACTOR/SERVICE REQUESTOR <br /> P!E EBTof ommit ue AapEEaa© <br /> q2). <br /> VAA;I Vl 4e Pe <br /> HOM Or Aotpese <br /> In TAN <br /> coy sTA'� -4 <br /> s. G At9dH9q'l,�j T:14 the undmigned prov" m baaiaess arraerr, operator or autharlmd RRW Or Nims, <br /> 0okpa Wge that 4l site a0dlor prnJect speCIAC li MR!)NMENTAr.WAI TM UEPARTMtrh'r hourly charges assoeieeed with this project <br /> or activity will be bitted W me m my buditu es idcrtil{ed on this fano. <br /> I ileo eattify*4 J bavo p weed Ibis applimIke and dmt 60 work to be.perfwmcd will be done to acccedaaoe with aU SAN JOAmN <br /> Cotwy©rdiaanm Coda.,Stdadarda STATE,as PED¢eALlaws. / ,I <br /> APPUCANT'S SIGMA7UIR6; mm If-AV-64 <br /> rmprittrt ammsF of rra uPKPXTORraa~ -CI vTRiaamRtarrxrs Acarrr Gl <br /> JfAPPLX4N7 it sot thCFffaALP4U TY P■Oe0f aWkO?t0iae to A"£t r"Nftd Ttrrr . <br /> AT1'1'1TA a �y'j��ctxu�1PiROrtMATiO$-When amumbie,Z,the ow r m Operator of the pmpeny looaWd et the <br /> above dm +do*es6, hereby aufrarin tho mloaro Of arty sed all more, gwiechnlml drra n&d mAm-mel"Wte a1teASt mm <br /> id8amac0A to rho SAN JWUM COUNTY BolEOh'M5NTA1.H6AL7H DEPARTMENT 0%FWxi"it is evnilabla and at the sa9J0 tim0 it is <br /> provided mime ormy tOptasentattve. <br /> TYPE of SERYI6E &M ,W: <br /> COIIEEaId: <br /> APPROVED 2)T: 6WL0VEEk 1 Dam G <br /> AEeIaumm; ;/I EwPtoTtEri 7)17 WIT: <br /> WhStlMot8Oro0jf%d $1 COW. PIE: <br /> Fee AennurA., IAmouM Paid `]q. DD PaymaRt oaN S2)- O� Vic. <br /> i payntanl TYim v'.. <br /> Imroles s **at ` �- Rete <br /> 61RVICG FCO.UFST FORxt <br /> EMD 4&0-= <br /> R4VISED 6-6-W <br /> PAYMEN <br /> RECEIVED <br /> MAY 2 5 2004 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br />