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APPLICATION FOR LIQUID WASTE PERMIT <br /> SANJOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P,O.BOX 988,904 EAST WEBER AVENUE,STOCKTON,CA 95201588 <br /> (709)4683420 <br /> NON REFUNDANtE PERMIT EXPIRES I YEAR FROM AT ISSUED <br /> MwP1.N M TI¢NNW <br /> MV[ATgNN11OEeV MANE TO TXElAN b1WMCOVMV F011APE1Mrt TO CONRPVCT IWOpI1 NEFALL TME V✓ON[OFBCNBEO. MBATICATRMNM/iOEM[OVUI,Nc[WEN eMI <br /> JIMONN LgMIY pEVEEOF4FM tR1E.LNAI�T/FII 8111O.1 ANO TXF RMOMOB OF XMI AAQMN LOIIMV RMLIC XFµTN IEPVICEn.ENVIIVMMENFK N[41N AMION. <br /> Jos ACCRUED..AEN, / 17-)S; y 2 U zELS�- <br /> OWF6I'.xAME 0/: ,OEKAJF.JO.A- AOOIU. wT.RE <br /> a1 <br /> coxrgmTon�Ll( J�4' /c Sr�}.CO �.u..RmN.. J •1 Nny,/r..N .//. m. 7/3��'t �J <br /> 6.roNTRAn.n Amtp 110E nroxE__ <br /> rvRE or Msm waN: Nw.NrIMUTRx E] w.vw.MmN 91 0 <br /> NO BFRS iYEIFM rEIMRTFO i IWIC 4WB1 N AVMAM!NTM Zd11ER OR[4lDRwv1 EMIL TYTM 1 1 MORE MM1v <br /> b MMwNXI ` <br /> FNEYUmM WRL EENL RCRENCE i COMMERCIALEJ 0!161 E] <br /> Fx..66 N 111'EJO NNTMNJMW OR.EaeIM.: '2. NNEA Or NAELOTO: <br /> CNAMOTFN M xOR TO A OR'EH OP,RET: l "C/ IR/RMIr OIL CXMACTRI: WATATAPEOERN <br /> EO11L TNNJORRAN TRAP mrYEFAYO w[m Nf.COMFMEy[ME V <br /> M'Y TRAIMAT NATO OUT.9 TO M[NF1 T: F UNOATRN Emvv Rry Im <br /> MLTRAmXE] FOF TVR �-1 tHR 6P TOn[NCLON irrwvENI <br /> EMCMxO UM[ NE.a IIENTN Or 6- A p TO NHR:M /EST gIMOAIdI��,L Mowwrry lMI <br /> PlT6em OWIOIN OFDM /MLFTONAAlWT; E1L mumAmN_E1g1Enry <br /> Mo. ❑mDm N Of FORCE TO NEARER:. fdMRATRX FWORXIY IME <br /> Mab.WTv 0 CERIN NU1691 ONfNCE IO NNARR:v, MuHDATNM FMAWIY 111E <br /> EWEv OWRTX LONG PRANCE M NEMER:WELL_gUNOArRN FRE@Ilr 1MF <br /> UWADm FONOE OWOTX LAOTHDEAT" O..IAN:F TO.HERE:V MUNDATION� PROPERTY IME <br /> I NNIER CERW THAT 1 HAW PREPARED TN.AWIICATXNI NR THAT THE WORK VAM N ROM M ACCOIR l IFITH IAN ANOUNTY <br /> AON COroM/.N[I.ANO RAT!..NR W IFR <br /> AND REmMTRM OF TWE MN JOAWM COUNTY.HOMEOWNER OR MENOM ARM'.NONATUK CEWTEE.THE gLLOWNq:Y CERDYTWT M INCrfiWIMMIL!M"WORK MR WWCH <br /> TWO RIMN NIMUED.I MEALL HOT EMROY ANY RRANN OR U H A MNMFR AA TO MCOME UWE=TO VOFXM .COMPENSATION IANY 0E CA1FOR11A' CCNfRACTM'E HOWARD OR <br /> RIMCONFMI.TIM MONAnK CIRTITI THE FOIEOVNIO:1 CEAIFY THAT M THE RRFUWN NLE OF T6 IOIR MR MACH TWO IOM!N ISSUED.1 MHNL EMROT RMOFN EIILFCI TO <br /> WOMMAN'Y COMRNAATON NA2 Of/CCAAJUMAN&A.- TINM AAT MITT CML M NXM M AOVMCE FOR ME�AMERFR,WPICTRIHI.COMEIRF PMWMO.JROW. '�J <br /> ERNmY ri e T1DL: �`�N'y .ATc / /-I�-�'J <br /> 0..T MNOPAW TO.1 C AN •N <br /> 1.HAUER OF ETMRE OR MADE NEAIIER TO OR 000NDMO THE W OMFFV A.LOCATON Or. IAL NREM M'ROM. <br /> E.ONTUNE OP THE RRIEWIY.WTIH MMR <br /> FROW.NR NOROI OCTRN. AIMIION OF NWAOE M.10 E <br /> O-OIMFMH.NO OUTUNEE AND.....OF ALL fTI.TI.ANO MRADOMR v. 0.lOCwrgM Of NTTNN ME MMOIEO FNTY FT.q1 <br /> IN:LUMNO GOVERN AREAS M H AS PAmg.. AY..NO W.W(.. TN[MO NLRNNO <br /> . . . . _....:. t :. C. _.. <br /> I-bHyt <br /> :3 <br /> PAYMENT. <br /> RECEIVED <br /> / NOV 21 1997 <br /> (gyp/ ;. <br /> 1 ' EHNNONMEpI'AWEE4.►jj A. <br /> NR OBARNWTIJ6 OxLT _ 1 <br /> AEWIeArRNAeecrtc.sr Ew`V •1 I W� DATO, II 1/7 1 a / / AREA: ` <br /> FAAR EEE OR .'A. <br /> ev 1 F_OATE I� ,If4F?�IFM,u MMECTRxR `U` W'1. Own <br /> Ao01TF N COL NEM.: <br /> AccoVNnxa <br /> OKI: um FAcr SODI <br /> R coM EA INN IMOwTAEMnm HE[ nEC Enm.Y Mn A1ENR.rMMw IINOICI• <br /> 38 <br />