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APPLICATION FOR LIOUID WASTE PERMIT <br /> SAN'JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.BOX 398,448 N,SAN JOAQUIN ST,STOCKTON,CA 96201-0388 <br /> (209)4683420 <br /> MOM-RO MOAYEE PERMIT UPFRE9 1 YEAR FROM DATE ITWED <br /> RbWpI in Trp&/b1 <br /> AFHMATNIN IB XEREBY MApE TO TNE6µJWOWN CpVNry fOgq FEpM?TO CON6rpVCiµppglN6TALL TN6 WpW(CE6CWBE0.THIP AAyCAnON OHMAGE INCOMRJpNCE WrIN eµ <br /> .tlA0U1X COLMYpFyELOPMEM TRLF,CXAPrFR9.1110.3µ0 THE 6TAMAROS OF"AH MADVIN Doo"FVBVC HEALTH SERNCEB,EHNrgN At.HEALTH OMgON. <br /> .Ipe ADDREecrop AFw/ '7ti h'/ k; //�+3 5'T' <br /> DRl' Trfra� IDT frZE_� <br /> DWNEWB NPME CJytrTN l- AvTo WrnoH'/y/�appR,:fi6_Se yEF PIwNF 93R-8x A73 <br /> J <br /> —on_ AxZ'hv XI 0 5av ADORE.. 6aa� 01-veg ver Avm.f90dn57'0 LLDd "/YY'F// Sq�NA ,Ty.y�tty <br /> m ODNFMDTO0. <br /> ADDr¢ee fT uer W+Dex <br /> 1.tOFC9IEC WORK: ..IHFTALLATMN❑ gpNWbpIWOM4 OFfTH,,Dm.R <br /> iM BFPrIC 4T6RM pFpdrRTFy If PVBMD HEWER Ig AVNlAB1E NTFHIN 2YOfFET OF BVIIDM0.1 PWC TOIT411 I NOW MANY <br /> ApgkWee/ <br /> IXMAL{ATpN WILL 68W6: gFSIpFNCF O COMMFACLLL® OTHER❑ <br /> NI.MHW OF IMNO UMRe:�XIMBWOFRFJXoOMd: NIMSW OF BAROYFFi: G- F <br /> CHMK,IEROFWLTOAOFFFHOF3FEET:NITr LOOM NT=MP.LCHARACTEA WATFfl TnSIE CEPIN���TA <br /> WDCTAXKpgEA1FTAAP lnTYPFJNFO Ihyp CAST CAPACITY /6 90 NO.COMPARTMEMB X <br /> RIDTRFATMWTRANTC ME,,AWr TONFMNT: 4VRy EO FOUNDATION yo, RgRRTY ZINC I001 <br /> IUaum 0N❑ SQF TYPE OF ROMP BANG OIL SEPAMTOR NNCLOBm BYSTFM <br /> FALIWYN6 ❑ N0.41EAtlTN OF YNFB DWTAXCET011FARF&r:WEIF fOuxpMION��gpRTpY VNE <br /> muMm ®"OtIL � LENGTH To' OEPTX T�OIBTNICE TO NEAgEBT:WHl„TQF �FOUNMTpN,fO pflppFr(rYVNF /OOH <br /> `480, m ES DiDTN LmGM DEPTX_�OWTNICETO NEAREBI:WTLL fOVNDATWN�PIK)pW(y UXE <br /> dFFIAOF NTd ❑pEylEl SOF NUMBFI��DgANCE TO NEAREST:WELL FOUNDATIOH•��ggPF3rrY YNE <br /> dUWa ❑WIDTH IENBTN OEPDI�pttANCETO NEAREST:WDF�MUNOAT..�PROROR,Wb �F <br /> p1614EAL PoNW ❑WlpRl {jHDTjI DETI` DMANCFTO NEAgE6T:VVQD FOUNDATNN..PflDRpTY yrb •�V'T <br /> I XFNBV CFRfEY THATIHAVE RYPAPFD TNIB AWLCATION AND TENTTXE WpW(WIIt BE pONE IN ACNMNKE WITH SNI JOAQVIN DOVMI'ORKNANDEH ARO BTATE tAWe,ANp RUIEb �I <br /> ANOAFDULATpNe OFTNEeAN JOApI11NCOUNR'.tpMEOWNW ORIICEY6tUASEM'B BIpXANRECRrIHFBTXFFOLLOVArb;•I CEgrIFYTHAT p!TXFPERJORMAKEOFTXE VAFN FOq WNW`N <br /> TNb RlIM1T10186VED•ISNN1 NOT MPLpy AHY PERBpN M SUCH A MANNER A6 TO fiKpd1E S{IgJECT TO W01KMµ'6COMPFNBATION LpWe OF CAUGORNIA.•CONERACtpp'8 pWNJ OR <br /> SUpCOM11AD1Rp N4INTVIIE CFRTIFIESTXE FOLLOWttp;T CfRRPY TMAi M TME PWPORNANCE OF THE WDRt PoR W'HICN TNIB F£RMR Ig bglEp,l&IPM.ENROV FEflWN6 gyJEOT Tp <br /> WOR(Mµ'B COMNTI��BApTO..N��FFU��WBO��F CAUFORVIA•TXE AP%ICAN}MVBT CALL 3d XOLRd IH ADVANCE FOR ALL REbBgm IXdIBROXd. COMFLETEOMWINOBELOW. � <br /> SgNED. !/�C U(QFldBFEO <br /> trrlE: CewTKw.oTFr <br /> ROT RNI PROW TO KAa, LE rn \'k <br /> t.NlMF60FbTIEET60R ROgp6 NFPAE6T TO OR BOUNpNS THE PgOPDRy, C LOCATION OF HOUSE MWAGE NGFND L 8Y8TEM OR p,,,MD 1' <br /> 20mlpE OFiHE RK)F£RTY,WTTN OPIEN6LN8MIp NpmH OVRCTIOM. E.[PANBION pF 9FWAOE O18108AL eYerEMg, <br /> J.00LUDNO LLOVr{Irff6 AHp ILOAo AATM3.= I AI ANO wkO .. 6IRVC}VPEB, d. LDD40o NCP NELBW 04 RADII' FONF NVNOIWp HFIYFT,pN ' <br /> INCLVOMO CDVpND ARAB BUCH A6 PATIOB,pNVEWAYq AM WA(Se. THE MORTRV OR AD.pININfi RgPflRY, <br /> N <br /> 0.,9oK <br /> weC L _.. <br /> PAYMENT <br /> T%re Shop gRECI:IVED <br /> MAY-1 i 19951. <br /> SAN JOAOLI'v COU NTY <br /> PUBLYD HEALTH SERVICES <br /> E�VIRONnAENTAL HEALT}{LSR'ISIONI <br /> //rh STx.OoT,..... _ ....... <br /> fOA OdMTMpT U6E OILY <br /> AWUDAnON ACCEPTED W <br /> V DATE__ ARA: <br /> TMFEP(I'00.WMP IN6FEtiRIH SY DATE <br /> ---L-2—RNAI IN6P[CTN�N/BY D �LJ�L/J�JJ�CCr R�� <br /> 4z-7; <br /> AODRIONAICpMMENTd: AC(CAMJ �•NN � F � R(,Y;[r.EE(f Q/ 3L {� 1 <br /> r ADDDUN}iva Dw.r, Arw <br /> FE CODE FRF INFO AMOUNT RO,8TIEO _ <br /> C EC ICAIN REC8YD19Y OAiE �'--�- ---, <br />