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07-29-1994 39:59,q'I FROM <br /> TO 14129675252 o.32 <br /> ' GENERAL PROCOX FILE New ✓ Lzange Eatt trxws) revised 5/21/93 <br /> FACILITY IQ f �/� FAC:ILlrr RAVE <br /> RECORD to ! PRIOR SUCEP4/COMP <br /> DAIRY: Grade A Grsde B Mlit DiapenaerWimber of Cantsfn!!s in Multt•Hesd Unit <br /> FOOD: Resta Market Cosnissery Hobite Food Proclaee StAnd tee Ptant <br /> ustiny cawity Sea Ft _ Market WFood Prep: Y / IN <br /> TeaF Facility <br /> I Spec al Food Event Vending Machines Ntlober of vean4tn8 units <br /> Food VA(cte Make License t Registration N Color <br /> HAZARDOUS VAS-TE: Tares Gavretew16- TIERED PERMIT Facility L CA _- _ CC Out <br /> _ HOUSING: Not 4/liotel go. of limits JolLJfxeMt Institution_ Housing Abatement <br /> emloyee Hensing No. of Employees] Approx Cates of Ootupsney � I to r•,fM <br /> LIQUID }CASTE.- e,vehicle Ptnpel r Yard Clseaticat Toilets No. Package Tx Plant <br /> XEOItAt,V=E. riew)r Care ACU%e Care Skilled Nursing to Wwator Sm Cererator <br /> YLvrab! (2.10} 3Lorage ( 3,50 } Transfer Sts _ Ltd Hainer_ Vet Clinic <br /> .,_ RECRfATIOHAL HfEALH: pool/Sps Number of Poots Out of Service Pool Natural Bathing Place <br /> v St1E NITICATION: Environ Assess VST/CAP Loc Hoz haste Naz Mat PPL <br /> �- Other teed Agonry Site Agercyl RV= OTSC__ XVL Site WNW 41 Othe" <br /> SOLID tASTZ t itl Transfer Sats Recycling Fee Paste Storeys Foe Ap Wsteltumpt site <br /> SSC VehiCtO No. i Du"uter � No. Stationary Compactor site <br /> VECTOR'.CCNTRUL: Poultry fatty wAx Ntsoiyer of atrds Krml <br /> EMERGENCY WtFICATICIO for this FACILITY and/or PROGRAM DAY NIGHT <br /> i <br /> CONTACTt C ) ( ) <br /> CONTACT Z <br /> I <br /> OESiGNAT6 WtOT o ,R PROGAtAII1;Lf)IF,IT a! QlRR£NT STA1� <br /> x Of UNITS EPA ID RS INSPECTION CIVe <br /> BILLING, aril COIiPt.IAN AC3JIWLEDC Ithe tndsrsfqncd anter, operator or agent of Sant, acbvwledg@ that all site and/or <br /> project spereIfie PRE EHD hourly charw associated with this facility or activity wilt be billed to the party idsntfflead as he <br /> BILLING PARTY an the I lore. I also Certify that I have prop+red this PWIestion and teat the +lett to be per-folaad vitt be dans <br /> in accordance with 4A applicable SAIL 10ACUIM =STY te+snee Codost adlor Standards and Suss wWor Foderst Lowy. <br /> i S <br /> y� AOPLICANThS SIGXATMI, <br /> Keith D. Coiamarino <br /> Title: Manag2r, R ulatory Affairs Date: . 07/29/94 <br /> AVTHIZA1t= 'to ACL iMFORNATIONs In *Wition to the 8b*", WWI' apptieabte, I„ tilt atn+t, operator or agent of ssioe, of <br /> OR <br /> the property best at he abate site aeddresa fiereby authorize the retaaso of any and At results. geotedunfeat Guts WAI*r <br /> enviad taL/site sment tnforeatfon td SAM �{W'#2IN OOIIM PtXI CC HEALTH Stet MS NVIROWIWAi. VALTH 3tYI5ICN am <br /> soots as <br /> r <br /> it Is weitabl'e and at the sou time It Isiprovided tee Cie or ny F*1x-Ow tstivr. <br /> i <br /> Fee 0.mount AtmVnt Paid Oate of Pernent Payaknt Type Readopt N check 0 Reevd By <br /> { <br /> f 23 I <br /> RENS ....t svvv ✓..r....f ACCT UNIT <br />