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TO 14094417539 H•Id4
<br /> 07-14-1995 09:530M FROM
<br /> °� •, 4V1tiJ 1 !~i�f'II-C ii1CC-�` -ju I1\1rur IV1N f lull rUrily! EC1-" VV l �fliavisad 6!9 r
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<br /> l Under Conelruelion I
<br /> � ` New Facitily ' '
<br /> SHADED SECTIONS Olt LOCAL USE O !y OWNER FILE INFORMATION!
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<br /> Piee�e cvmnplete.tlse foUowing jacility D�NN information.
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<br /> Maii!lg Addlae
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<br /> If D!¢EfREIVT fiom Owner Address � �Qj�
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<br /> NieiliIlp Address,City iI /7 a r S�!
<br /> 'ryat�eas LadI f O Buelneae� pP 1 r
<br /> f FACILITY FILE INFORMATION!
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<br /> 'leas Complete ilia followi 'p FACILITY information:
<br /> feoR y/Bualneei N*o%e�(Tlrls w19 b IVAI ort Nsi dr pofft t r
<br /> FnclCrcy 1lddraes.Nr Fseifir)vo is a Mob l®Food LJbir:cr Vohiclo,•Sao 6olaw) I miuoineool PhonoCity
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<br /> Mei q Acldtee11III 111e1fb Pgrndd
<br />{ if.O1FIFfR1:A/T from Fdciliry Addrnya � 'l 'r is '
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<br /> cittfq I<SInt Allelrtion
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<br /> Mair, Addrosi City i State ! ZIP
<br />} `,•SrY,MQ+lA S _'js ° ,L1aL AofIImY SIaCtle CRdst - o-- .GanaYtl!type+or BU61I a et IIL�d
<br /> Location
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<br /> J sia�mlifir A.idrn_ �; 'i I
<br /> Busi a Nome
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<br /> Addr7os of OParplion ! Q l e �O 1I Phone
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<br /> Cly 1. State Z7P
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<br /> ,3 i✓r37r ��-i•r it•�`in"�"# �° z5x s dY..
<br /> Send SIC lnvt ices'fo,r Permit and ervice FEES to: farcle alae
<br /> OWNER FACILITY/13I1SIN SS
<br /> IFR, A EH 00.59 di WATT TEM iEH 00 59w form,must ba comnple#fid Tor' .Environmental Health regulate
<br /> ihratlt�ry at 46's LOGATIOW:excevil UST Program Wso SWRCB forlllsl
<br /> e4 v9! �y 41a # rV [e rF h pun Nf4 ran ear�� > r N 1� a r' t {F g' etP`i��rY�•
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<br /> TOTAL P.04
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