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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN'JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P,O. BOX NO,304 EAST WEBER AVENUE,STOCKTON,CA WMI0 88 <br /> 1209I 468-3420 <br /> APA ' a0�1-ld-o -vim <br /> 801 REFUROABLE PERMIT EXPIRES I YEAR EROM DATE ISSUERn J� O <br /> �b �! <br /> APPLICATION le HERESY MwOF TO THE SAN JpA0U1N COUNTY MR APfpMIT TO C ICORPWU IR T1411f{lfl 8p` <br /> ON.IpUCT..O RW.TALL THE MRS DESCRIBED, TN[APPLICATION le MADE WCOMIVNIL[WITHIMI <br /> JOAOUIN COUNTY OEWLORAEM TITLE,CHAPTER 9-1110.3 AND THE STANDARDS OF BAN JOAO/IN COVMY NBLC HEALTH{gVCA,ENNMNMEMAL HEALTH MN.CN. <br /> JOB AooREcemn APNI11040 S. Lod 4 k7(r cm V 3 � <br /> OT MA_ <br /> ovmfWe uwME SQ n7 (_O of /, Moxea0� <br /> 111IT11 �[}� I ISL- �u.11�r wowM.e,_ �.Yj_� cYw y/hq.a�� { &ojr�-q 71 <br /> c <br /> _ .U[CONTRACTORMHONE <br /> A.D... U`l <br /> TYPE OFifI1M WOIOL: HIM DMICLUCCUM, —M ..T10X❑ OBSTRUBm"13 <br /> WO BEPTC SYSTEM PERMITTED N PUBLIC SEWER IB AVAILABLE WRHIN COO FEET OF.UCTIN0.1 PqC T4Tb1{1XMW Ntlry E V <br /> A.M ex <br /> INRALLATION WILL[ERV[: RESIDENCE COMMfPCIAL❑ 1, OTHER❑ � <br /> — NUMBER OF UMNO UNIT.: �NIM.M W\FOIIOOMIis �1 NIM\q OF WROYf[e: I <br /> CHARACTER Of 601L TO A DEPTH Of�J f/EST -r WG PRT/.UMPCON CHAMCTEn: N/- WATER TAME DEPT�1 SCAN JOAOUIN COUNTY <br /> SEUL TANN/ORFA..T. LC TYPF/MHE IO,}li �T1b��MSEflVNiES <br /> cAP.cmND,coMPARIR TAI NEAITH DIN31ON <br /> NOTNgTMgiPLANT❑ giTAXCI TO MiM4T: WELLjima_ MVNOATION 1/] ROME—un, 106r <br /> LIFT.TARONO &If TYPEOf MMP�r[ANO OIL SEPARATOR IENCLOSED[Y[TELE <br /> l4CNNO MM[ Er...UEWTH OF LINE\ ,7-'`�5 OBTANCl M.F R.T:MU, E.b al MyNpA}CN �S gIpFEIMry UNE <br /> HITq\ER ❑WIDTH LFMiX pFPTN—DIRANCf TO HEADIER:M'[LL MUNDATCNpM14pry LER{---�= <br /> MOUNDED ❑'M.TN UNOTH OEPTM OTANC{TO NEARER:Y2LL MUNDATON�FROPERY INJ! <br /> .[EP.OE RT. 1Q,/DfRN , WEENUMBER ORANGE TO NEARER:WELL FOUNDATION Rp1ERry LER{ <br /> .IMF. EN WIOTM _LEIJpTH Io_OEFTNI(O..'M HEARER:W[LL=MRNDATbu O PPWWRy Me <br /> .MM.AL bX0\ ❑..TN LEHOTN WINS ORANGE TO NEAREST:WELL�MyNpATCH�T01[RTy ly( <br /> I HEN\Y COST"THAT I HAVE PREPARED THIS AfPiICAiCN AM TIUT TNf WOq WILL SE GONE M ACCOMANC{WRN!/JI JOAWIN COVNry OMWAHCES AJD rtATf MAW.,N1p WOE\ <br /> yM. AND REWUTCNS OF THE AN JOAOIN COUNTY.MME OWMER OFLCEN.EO AOEM'e SIGNATURE CFRNI{.THE MUO M:TCC""THAT W THE PfNORMAME OF THIS MR FOR VMCH <br /> THIS PERMIT It ISSUED,I MALL MT EMPLOY MT IRWN W SUCH A MANNER M TO BECOME SUBJECT TO WV ROMANY COMPENSATCN LAW.OF CAUFWNU.- COMMCMWS NIR R,0. <br /> WS COMMCTINO SIGNATURE CEED"WS THE MUOVA NG;'I CERT[Y THAT W THE PERFORMANCE OF THE WORD MR MMICH THIS FENAR IS"WED.I.HALL EMPLOY M.N..U.IFIT TO <br /> WORKMAN'S COMPENSATION NWB Of CAUIF/ORRNA�—THE APPLICANT MUST CALL EA W W IN AOVAXC[MR ALL p[06IgW INSFBTON\. COMPLETE WAWIHO BELO . <br /> r MNM[ ` �! A, �V`� TYLE: L-al Tf ti'I'nt' DATE: � �LC 0 <br /> ROT MN CRAW TO WMEI WAf •N <br /> I,NAME!OF RRR.On MAO.HEADIER TO On BOUNDING THE PROPERTY. M.LOCATION OF NDLM MNYAOE OBMBA RREM On PMM.E. _ <br /> F. OUTIINE OF THE R MEFTY,MH DIMENSIONS AND NOR"DIRECTION. ERPµBpN OF.EWAOE M.M.A 1M...O, INMENSNINED OUTUNf.AND LOCATION OF AM-l STM.ANO FMM.EO.TRUCTUM., [.LOCATION Of M Us MRNn MDU.OF-HE HUNDRED III M 0. <br /> INCLUDING COVERED MEAS BUC.A.PATC..ORVRAAY.,AND WAUK.. THE PTCPERTI'OR ADJ ININOP PESTY. <br /> 1p� 0 <br /> a <br /> g T <br /> p w >ar <br /> FOn o M T All ONLY <br /> s APPUr . ON ACCEPTED BY iI,M1AYl L f - 1 W ^-U() ` OATSI R/ ATMA: <br /> TANK,RT OR SUMP INSFMTWN BY DATE / /ADDITIONALFINAL CTCNS <br /> ADDITIONCOMMEMB: <br /> ACCOVNTING ONLY: AIOI FACE <br /> PECOOf F[f INFO AMDUHTngUTTM CH.CIUICASN I RECOVER\Y OAT[ M/PERMIT NLM.M INVOICII <br />