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APPLICATION FOR LIQUID WASTE PERMIT <br /> SAN'JOAOUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O.SOX SW 904 EAST WEBER AVENUE,STOCKTON.CA SMI-388 <br /> 1209)4883420 <br /> NONREFUNDABLE PERMH EMPIRES 1 YEAR FROM GATE ISSUED <br /> (C. ISM M T,IPRESM) <br /> M}MCATION IR XERdY MACE TO TXE 8d JOAWM COUNTY FOP AEEMMT TO DS or <br /> CT ANONR ICOUN1 TXE M HI UTH SePo. M.E MAONMENT IB MAGE IH RRGOON/JICE W1M SAN <br /> AAWIX COUNTY OEVELO FMEM iRIE.CHARTER 0.1110.)AND THE BfINDMDB DF BM'AAWM COVNIV AIBUC MGLTI BEPNCEi.ENNPOHMEMAL MEµTX pNYON. <br /> DS ADw¢.eDn AFM, 'v''277� Cm /�s�.flvs-Lri 61D WT-,.2&d,!. <br /> E C9, r�iD�arOx/SCS ADOPEes AND 7sts'8.S/S <br /> c.HTvcron v l•���_ DEMS./Z/e cRc.+t E. LICE E C rfwNESL�i3-53�i <br /> we caxrw.cion MONE.. L1CR wDIA <br /> IF..1 M.woRIL: xaw MaEALUTDx Ilouw.Bwn.x O DUT11ucTDx[7 Q" <br /> MO Sol.SYSTEM HIMTTEO R MGM..A IB AVAMBLE WR.N.1.FEET of....] F6K TBTNl I I Ww MMIY <br /> AP/saRl• �_ <br /> INETAwnoN WILL SERVE: RESIDENCEy COMMERCIAL❑ OTHER❑ <br /> _ <br /> POF Lra- .:--L----OF.iDxOOM.:�ROME61 OFMMgqVF��4: ,I <br /> CN♦�11S�[T\d Of 801LTD A...Of.RET: _ AMMFwyx CHARACTER>e&` • 1 WRTEILTAG1E OfIIN 4EJ E� <br /> KOi1C T.IFl14WGaE rRAF ❑TYFEAI 'SSJ{L/C MACRY L7t0A f�eE xO.COWNIfF!(11 2 <br /> TREATMENTY <br /> FXT 0 pETA.CE TO FRAHM: WELL`O � FOVNDATbN .- Ro r <br /> LAT STATION 0 MEE TYPE OF NMF BAND OR SEPARATOR(ENCLOSED ISTEGO _ I <br /> LEMMNO... ';gND..VHOTX OF UHER Z- EFOe /.Tv"!. ENST.ETOXFM1ESl. /OO AIC.IOVHWTDN�PMERTY LSE 7S L <br /> ROTOR BEo ❑ LE. DEfn, pBTANCE TO NEAREST:MAIM ITAGRATHO. PMRRfY RINE <br /> MOUNDED (❑�NWTN IENOTN OdTM peTANCE TO NEAREST:WELLe��� FOUNDATION <br /> �/� FRIfERIY VMF <br /> tRFAOE FIT. rya. DOE '3(0" NUMBER�MVMCETONEMFST:W L!2L�FDUN ON&O' PROPERTY LME 7S <br /> .WF. L0 WIOTX LENGTH_. peTAHCE TO NEAREST:WELL FOVNDATWN PROPERTY UNE <br /> gaPo.LL FOX.. OWaTn. LLNGTN oard AHCE TO NEAREST:WML No.... Mr,UHE <br /> AT 1 HAER PPEPAMD THIG ARiICATION AND TNA THE",WILL BE DOME IH ACCOMANCE WIN am JOAWIN 1111*FE NANDES AND 111IANH,AND RULES <br /> .REOV TNFHSO TXEBANJOAOpN[DVMY.NOMEONMEAORU AGEM'B MONATVIECERTx1E.THEPoLLOWINO:'ICEMW ATMMPREOFMAHCEOFTEWVMFOAWHICH <br /> =M"SI <br /> NOiE R MaVCXA EER AS TO YCOME.VSJECTTO`FORLMAN'a COMFFMeATM)H UWS Of CN1FORMl...' COMMCTOR'B HIWNO OR <br /> . CEMI OY AM'RWMO.''I CEPA TNA HTWE RWORMANCEOF MEWOM MRWNICHTXIBRNAI I.Ia.M..ALL EMROYPERSONB SUBEETTO <br /> AW. . MNN EfXOU11.US ADVANCE F ME REEMAND I N.FFEEDMONL COMPLETE OMWINO MOW. <br /> .I ( �'C-SR LAY'/ TF0.01 FEAR RRMW TO SCALD SCALES RTO OR SOUNpW THE RIDFEA,Y. E.LOCINEW OF HOUSE..I bFSMI SYSTEM OR FROM O <br /> OMUME OF THE WDM...WIN DIMdSX)H.AND NORM DOICT.M. GPANMON OF SEWAAE pMOSAL SYSTEMS. <br /> ]. ..ENMONED ODTUMAS AND LOCATgX or A L EE.AID...rtILVRUREe. A.LOCAT WN OF VMS NRMH RAEADS Of Oft MMDMD FNTV IT,ON <br /> NCLUOINO COVERO AREAE SUCH M RAIDS.DRYEV/AYS.N WN%.. THE RUPENTV OR ADMGM.O FRO STY. <br /> r <br /> FARTHAEN <br /> 3L,/xzs , <br /> 1_Mz JLC �J�IA �Ltbs'`— <br /> rlDssc S. <br /> _ SSSS <br /> (^ ��/L�(\,���� T ..IT ' I 'j l <br /> _ APPLICATION ACCEPTED BY `. _ BOE! yJy —DATE: NEA:y 44 <br /> TAM,PR OR wMF INSPECTS)..1DATE / / M INeRCTH)N.Y ��DATE <br /> ADDRIOHAL COMMENTS:1,�e'a'G�I Int/ IGecL 4—t,4D IArG/I <br /> r <br /> ONLY: A10I <br /> IE cooE FEEINFo AMOVNTRP.Rd ;eAm F.Eft.BY OATF M/FEMiXVNSE INVpC{ <br /> 4 z Il 165 P 4D a I 036,1 <br />