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00027/ <br /> APPLICATION FOR LIDUID WASTE PERMIT <br /> SAN'JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 988,904 EAST WEBER AVENUE,STOCKTON,CA 85201-080 <br /> (205)460-3410 <br /> NON REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE 1881) <br /> RkEybb In T,*Nb1.) <br /> Mn.ICATMN b HFXEXY MMF TO THE BM`JOwOdN COVIIIY fOn/,FFXMrt TO CONeTfl11CI ANONN MBIALL TXF N'OK DEKMEL.TN,B.VRIC/.TpN 18 MMF MCwIR1.ViCE WfH 8AN <br /> JOAb11N COVNIY MMOPMENT11fM CXAJTEETA&1110.3AA�NDTN//EnBIANOMOe OF SAN AAWMCOUN "Lx'NFµTN BFnVICEe NYMONyLFff1LNGLTN dNBpH. <br /> MM NDONECWOX I:MI l ) �' f/ `i1e�/?AJ CT•—�OE{Al// LOT CDT fH <br /> ,.Q TMONE�V y <br /> OWNER NwME �{�/'L � iitl+ � AOon¢ei <br /> caNrwA:TOA A-r. /'OADDNELX Uc.133G�$ MwNF 3/Gu�i� <br /> EUX coNTAAGTOA ADDHEn LK. .HE <br /> rrKwCEfd:Wqp;; NEW MTN M.❑ X AWADMTON O4TMMIwx❑ <br /> 1N0 BLVTf:BYpiMpW1TTED IFf CO EAB NVNIIntE MTNMCOOFERO(WILDDAI.I Mc Two)(1 NOW MANY <br /> OrApp9sfon C <br /> INCTAWTON WILL fONC IEMOBICE 13COMMERCIAL O OT..❑ <br /> M m Of UMNO OMT.:_NIMe1 w iCb100Mf: Nvw O w/ oncm: (� <br /> CHNM M OF NOR.TO A DEPTH OF 3 FELT: M) WX CHAMCTER; WATEIL T. DEATH_v <br /> FFPIIf TAX4ORO1EC 1Ml ❑TrCF/Mfp CMACIry 1q.GOMpMIMLMB T�..J <br /> KO 111FAlMLYT CLAMI Q dNT.,TO MEEm., WELL FOUNDATION RpiMY UNE <br /> Li "AEWNO�NEE�^�T OFPJI.M I' FANO OE WARATON QXCLOND WYj <br /> WI .UXF NOS wl(NOTN pF.... 1^ 4,>- dOrAXCCTO NFAIEfF;WFII. 1NINP1bIFnTY WE /� ' <br /> MTFA em ❑WROTH IENOTN Of"H�_afTANCE TO NEMEET:N6L fOUMATION,��PMPFMY UNF <br /> �M��O�U�ND''®'+.1T��j ❑WIOTNIEFMTH pDFTN NFTNICE TO HEMfCT.KOLL .LTION���CNRATYIINE Q <br /> j ❑DEPTH– �fQE�,c,3�c'r NUMNR deTANCE TO NFAIkeT:N4LL�II T,D.�Q�mmR ZJE <br /> .wm ❑WMT" LFNOTN pmT11 dNNICE TO NEAREST:VIELL.FaVROATION.PnoE LROF O <br /> dFPoFAL qXO[ E3 wwH LENOTH DnRANCf TO NEAREST.ML c) <br /> L) <br /> I"MAY CIATW THAT I HAVE MEFARED TML APPUCMb0 ANO THAT THE WOK YML N GONE M I MANE m WITX NµJpAd COUNTY pAgMANC[e ANO ETATE LAKY.AND <br /> AIILEt 1?l\ <br /> AM REOW.TN»IL Ot TXE EAA.pAdgM[OU(ry,NOMEONMfAOAICEMNOApfNT'L ApNI1TUK Cl11nHELTHFPoIIIXV[M:}CENTIFYTNATMTl1F Ff1OOIMNICEwTIEWOKMN \� <br /> THXI Pf1W R IB IwVEp,I WNL NOT EMROY NfI pFIIWN N CIICM A M.WNEn A8 TO NCOME NMJECTTO Npfl(MN1'8 COMMNMTIONUWXw G.tYONIIA.' CONTMCIOIT[M <br /> M NFMATPACO BGAA LC OFCTHEFOLL01NN0:'1CLRFY THATMTIRE 1EIEOIMMICE ONTHFN'OK Fd1KNICH TME RIKtlTMICEUFD, BINL fMROY PpILpHB WUFCi TO <br /> NbKMAN'6 C�OX'i'E'Ne�AE'TNM 1AWe OF C/A/4fO�TA1/8A• )ME YFIKRNT MUST CwLLbNOU11FMAOVMK'I FOA/�M/1,I AF�KMI®MEPBTNXM. COWIETFd1AYR,NI nELOW. <br /> NeMFO II <br /> ROT FLAN WA.TO FCALFI LONE ro <br /> 1. NAMEe Of NRfETB ORMMBIEARER TO GA LOIRx11NO TNF ggR11TY. A LOCATXTN OF <br /> e HONKADf N.-ALw nLMPoND <br /> E.OUTIINE Of THE pNIFLTry,KRH gMENMNC ANO N011TH DOEC110N, MANSWON OF NWAOE OMPIeAL a ETINHL <br /> S.TIWMMNFD OUFUNEf AND MCATRN OF ALL pAETIW AN0 PHOO FTNJCTy1EC, XLOCATCNw WRLi WITMN RM111N OFONE M1NdmfET'R,wl <br /> MLMNO COVERED ME/.ES M PA130k DE AYE,AND WAIN& THE FFFPEIRYORAOJDWNO g1wE11ry, <br /> 41, <br /> � I <br /> L <br /> ���i y <br /> � Mp <br /> A WARTE1T MOW, <br /> AMWATION ACCEPTED fY C 92N�� DATE: ` O l ! fs <br /> • <br /> TANK,FIT OR 6U WN CTM"EY DATE 1 I EYIM INbSCTgN EY GATE b <br /> ADN..ALCOMMNrte: " O <br /> C <br /> ACCOIMnxO OKv mo .ACF <br /> f[eooE FEe INFO Nam,EBNnFD xEC xAEN nLCEV®Lr owT[ K)PEfMTNVMq INVOICE. <br /> a a.So Ip Ol0 p3a57 <br />