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APPLICATION FOR UQUIO WASTE PERMIT <br /> AK, SAN JOAQUIN COUNTY PUBLIC HEALTH SER%l. .S <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 0/3 <br /> (209)459.3420 <br /> LFFO�REFUROARLE PERMIT EXPIRES 1 YEAR FROM DATE ISSVLD <br /> (bRPyb M TFyE.AId <br /> .MVCAIpMOMRNY M/i[TO TNI MN JOAOUb COVMVIOIIA RNAR iO CONRRVCT AIIOpRIXR.LLI TIR NOIR OEtCRIRFO. iMIt AM1VCAIpNMM1DCIN COMAIANCF WIIN[/.N <br /> MAgNII COUNTY OMLOfMLM 111.1,CNNFLII it l lO.a MO iM[RNIOIb[01[N!JOAOVIN LOVMY.[LIC X[RL1X YRNCFt.FIMFOMNFM.LL MLLLTN qNW N. <br /> ]DF Aoo.e.wRArxF �l0 9 W F.�EwceT EO / cmT-//Pi.P LOT PDE_ <br /> owMR':NAMe Im FY �A.(�LITiPi AOMFCM //o,fi/�LJJP I> ^ <br /> LOMIIIGrON /{. /W kG/LC /� AD... /S /7n < �.�/Qi.�UCS=/.S RpNC �SI <br /> MN rox1MCTon ADMFu LICIF NONE_ <br /> TYR OF M. MEW INRLLLL1pN❑ RfaMWA00TpN OiwH.VCOON 0 — <br /> w KFTM[VREM FUOR[O If N[UC KMA 10 AVNWLE WIIHIN 200 ISR OF tVIIANO.I I FEF L"..I 1 MOW MIWT <br /> INRAIIAiIOM WILL.NVL Rl&O El C..AUUFAL❑ OTNER❑ /ISA_C G C LG <br /> _ Y1M[g p 1NM0 VMI.:_NVA[EFI Of[@IIOIIMtr M4M.P OF FMItOYd: <br /> CN/JUCTFN OI O0.TO ADFYFN Of]PER: KIMUMP[OILCNMVLEG: ..TA[.,mFTq 1Oe <br /> tErt1e TAN.OIDAI[TNJ OriPD.RD —tyz 'v ND.roMPARMENT. -42— <br /> .0 <br /> .0 TuATMDFT FLAN 0 =ATAxCl TD MANMr: wEu /iin+igT FOIIF'DATION�/aT PMPErtR Lv+e <br /> IRT[TATO.0 Mrf TVK Of NMP [AIID OF.RVA UHv.W.UH FO rv[LEMI <br /> LCAONNO YN[ .13 N0..uF T FLNCt OUT...TO NCMCR:WELL IOMIgATN,N `AUAFFDV UN! <br /> KID ,R 'J <br /> LM IIAMITHLFNOTI OFIREOFIFX PRANL[TO NlAKR:WEI -FO...ATNIN_FRTRp14NTVW1! <br /> WWOfD []WI1 1lNOTH O[RH�DOFT Cg TO MEMBRI Mtt FOUNOATMN�P FUKFIV WE <br /> :FONDS PHA OOVFX SLE[ FAIT.IED1—OUT—E TO NEAKRI WELL PoONDATIUNRMVLm <br /> :WM ❑WAFX LINOrN O —DIRANCL TO MEANER'WELL—PoUNDATIONA FUAUUT I.IIE <br /> J Pt10:M IONO: ❑MUTH LWMN DEF'FH�CIFTAHOE TO HL.LRRI WELL�IWNDATpN�FTpPFMYUNE <br /> 1 HFNERV CDFTW THAT 1 HAVE FRPMEO TM!AM ATgN AND THAT THE MIIR.FE UGHU,IN ACCOAOA FCL VTH tM!MAWIN COUNTY DMNIMC[:N10 RAT!LAW[.AND MILE: <br /> /J1p RFDUTAMH.OF THA IMI AAWw COUNTY.HOW ONNO1 ONlpE...AOFM'L MONATUPF CERMEF THE PoLLON41Or 9 CFRmTNATMINFFLTOIMMIL!"',HHAO'IO11 WIRCN <br /> TIM RIYRI:ItAV[D,IFNMt NOT[LYVIV IXI MYOMMNCXA MMIMRAt TO ELLOMF NFhRTO N01[LMMi'F COMF4NU.1pN NMM OF CAWOMl1A.' LOMMCTOMI MWNO OR <br /> _ RWLOMMCOIAF FOHATVHI-CERT1FIft .AF .-WIHO:'I CEIRNV TNAT IN TXI KIROMA.LNc[OATM NOIN PoN WTMLNTXIt 1ERFAFI I[IMVLD.I M.UL[MPLOV I4A®Nt W61RTT0 <br /> NpgtYMl'[COMRNRAipM/IAWR OF C.YIFOwATM!AIMICANT MV]T CILLL 2{IpIIY IN ADVANCE IO.M[[L MDW101M[MCTpN:.COMRFIS M.WINO!E{DW. <br /> wMC R �P 4/ TTME: C DATE: <br /> vv wl PLw ENuw iD FDAUI RM] <br /> .— 1.MANE.OF.I .MG <br /> ...NR[R rO..wU..THE PAD.. I. <br /> LOCArpN OF HOUSE...O W aw rvRLM OR PKHORD <br /> THAIAM <br /> 2.D..OF TFK ITY,..O.FENwN.ANO NORH gI 0-1 E%P.VIWM OF.AVAGE OIRIOAM rvRCMt. <br /> ]. pMEMwFEU OVTIl1FF AHO LOCATNIN OF ALL Ir I.TIHO AND PKIFO.0 RRUCTIlI0.:. [.LOCATpN OF WELL:...H RMIV.OF DN['AH' EO FIFTY FT.OA <br /> FCLVOIMO LOVEPED NGL[NKH A.PATp.,DIUVEWAV..AND WNKF. THE PIpRF1TY ON AOJONIINO iHD.FTY. <br /> _ 2L j✓v/�-� - <br /> - - 3� r E <br /> — t Q <br /> Vv <br /> i\ <br /> o�,L <br /> 89 , <br /> ENtl]JH�A4T+1 "Io " <br /> tF IgONMEN'(PIHc?TH DIVI5111�- - <br /> MN DPMIMpi WE ONLY V <br /> Artlrc ArrON wccEVIED Rr DAT! AIG/.: <br /> urO..AT OR...I rxertcTlm/!V DAT[ "AU,o MLCTOO.ry v OA't 2 E <br /> 8•/O•,` •R.TTYD 4L eltstm4 4&r&—I> <br /> A WIIIONH COMMEHi6'. <br /> ffi <br /> HD - ? ! A N TD alN O <br /> g _49 a� <br /> caxNnxD OHLv: MOF FACR <br /> N c]DE TAIMNI <br /> D <br /> D TIIDAIT R.0 FNM dDL'lD:r el1Te M/AIFRR.ww INvO1c[J.N„ <br /> I Pun.How.soN.-E�^ro7.174(M4) ��7� �XA.,': i5:.: 7"Pgay/ &",�P .q�ty�Jm <br /> �-( �� 2'JV 2i✓� _ . a .e n'n-l_ A. tin A. -{nzPnt�(� <br />