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PAYMENT <br /> APPLICATION FOR LIQUID WASTE PERMIT RECEIVED <br /> A. SAN JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION SEP G 2000 <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468.3420 SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> IBP WWREFBRDAStE PERMIT EXPIRES I YEAR FROM 00.7E ISSUED ENVIRD14MENTAL HEAISH DIVISION <br /> IC.1nPYM 1.MPReBId <br /> AR CATION M HEREBY MAGE TO TRE BAN JOAOUM COUNTY MR A PDAVT TO CONST T MDTP NUr THEM W DEKROMO THIS AfAJC H I6 MADE IN MMNANLF 18TH.M <br /> MAW.C011MV...HT T�RIS C/\1�MTEN 8-111/0.9 ANO rO7 I F SANJ1 UJOAOM COUNTY M.M HEALTH OE"VICE..ENVTJ _ AAL HEALT/;DRAMN. <br /> JOB ADDBa/OP AMI /Lr 1 <br /> �c' ,1 y[t OCRY rl'C` lli."1 CS�Y Il"]c I.T 62F_ <br /> R <br /> �owXEn.xAME.e� ''EPL' m .E 9 >'7i')7/ <br /> COMIMCTOA I'1J)a,I c A AODDE66 UCI MORE <br /> sue roxrMcraR ADDRes �tl.' ucI P10M <br /> �TYR OF CwONR: xfW MBTALun RVAWAOp11ox ❑ OF3inucnoN❑ <br /> IMO eEPrIC W6FEM IERMITTEO IF PVBUC 6EWEP IB AVMIABLE WITMN EOD GEST <br /> OF By11DIN0.l 191C TEW..,l 1 NOW M <br /> APWetlen/ <br /> INETALIAIION Wx169NF: ReNENCE❑ COMMEFLIAL❑ OTN <br /> _N <br /> IMq OF EMKO YNIiE; MMgOF6FpMORN NIRASI OF FROT. II: <br /> CHAMCfER OF PTI9UMF 600.CNAPACTFP: WATEfl TAB1E OEPIX <br /> EEVOC TAN q� ❑TYFF/MF0 CPPACItt NO.[OMPAIIfMEM6 <br /> RO TREATFJ paiANCE TO MDEnpT: WELL MUHOATTOH-- PM11PE1fFY 1JNF <br /> IRTT...T,.❑ WE TYPE OF MMP 6AN0 OR SEPARATOR IENCIOBED EWR <br /> �.FAL'MMD UXE ❑ MO.SI SNOT.OF LOW. WSTAM:E TO NEAIE.T:WELL MDNDATAHGRIIEFDy..E <br /> RITEA.EO [3 IENOTH DETH_PRANCE TO NEAREST:WELL VMOATON PRDRE UNE <br /> MOUNDED ❑WDTI URMTH MP WETANCE TO NF SET:WELLFODNDATAN�FPA TEARY UNF <br /> aFDAOE PTF DDEPRI BDE HMISER�pR,AARA TO REAEET:WDLL FOUMOA.H--i RRR`DHE <br /> .LEAPS OWIDTX IFNOTI DEFTH�p6TANCE TO NEAIERT:WELL FOUNDATION�RRDH, TV UNE <br /> _...AL P]NO. ❑WE1FH IEMITN DE9THDHDANCE TO XEARFET:WEU.F MATMR P RERYUNE <br /> I HEREBY CEPTVY THAT I HAVE P FAAEP TMB 1PMCATMN AND THAT THE MT1R WX16E DONE Iry ACCORDANCE WRN BAN JDAOUM CODMY O...E.AND STATE SAW..AM RMPI <br /> AND ROVLA..OF THE BMJJ(1AgI1NCO11MV.NOME OMMEHORUCgWD AOEM'S WONATIIPE CERTWEB THEFOELOWIND:'1.M lTHAT W TME RWOIMAMF OF THE WDIR FOR" <br /> T1HB f4PoAR M1tS�1ff�EPSELL NOT eMROy ANY GEPMNMNCNAM4lNEPMTO BECOME WIBJER TO MOPEMAN'S COMRNSATgN UW.OF CAUFORM0.' COMMCTOR'B MPNO OR <br /> V&COMPACTBM 6IONAlD1E CERTIFIEaTXJJE��'MLLOMARO: cm,, ,ATMTHEPEROIMMNEOFTNEM WMR.'MCHTMERRMITIS1aBMD.I WNI EMROY FflISONS SVS.RCTTO <br /> �V.9RMPN'S CQMPE116ATpN 1.OF CCDM A' INE ULAN MUeT CALL N NOW IX ADVANCE FO.ALL REO ....RLTDN., CDAO E OM•MND BEL/O)W( n/ <br /> F.D..x Y--� L'�d �1 '/ - /(" /l TITLE: ///[-l.1/':!'E,d J OATS: <br /> ROT RUN IDM.TO 6CALL1 R'AEE <br /> E.OF BTE£Te OR..ANEAREST TO OR RON...THE ROFERTv. •,O A. LM ATNIX OF M..SWVAOE...S EFaTEM OR FRO,D. <br /> J.OIREME OF TM fT]RTRY.WITH MMENWON.AND NORTH OXRCTX N. ERP.WBpN OF SEWAOE..FD.AL a... <br /> O,MENWOMO ODTIME.AND LOCAIMN OF ALL E FTINO AIA HIDMSED STWRUR6. 6.LO ..OF WELL.WIT.. .OF DME..M. <br /> 11.ON <br /> ].MCLVOMO COVERED A 8 SUCH N PAT..,DAVWWAY6.AND WAIR6. TR.HERTY OR APb..FRPFERTY. <br /> R.y C' S�:' -E,ir� �C{..L (Lll-�''L17c-titin �'l, e.lt� .� C.tt•i[ilc;_ I� <br /> Ci <br /> y <br /> ....._... . <br /> PDP ovAPTMgtivae <br /> ppRICRIIOry ACCETTED By— oNLr� L' OATS wR ' 6 <br /> IAM..PIT OR BUMP m.RCTMiI SY DATE / / FINAL INSF£RIOH.V I �� <br /> PDOMNAL COMMENTS' <br /> r6. <br /> ACI <br /> OOEF.M. P ..T FEAR TEO c11FCM EMIFCEIVFO.1 DATE MI FEMRT MIMiq F.FDEI <br /> R., Zsa zs `�- �.: .,- `1 (. Df'• 2002391 <br /> `ue.Health Serv.-Er Iro.174(9 6) <br /> V <br />