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JON= =wry PUBLIC ID; M SERVICES <br /> 1MVIROMICU W, ItfALTR DIVISION <br /> SITP NITIOATION MTS1=ILS RECORD rORM <br /> GENERAL PROGRAM FILES t/er GSdBge R61t (PVW4) revised 5/27/94 <br /> FACILITY ID a V.%=ZTY MM <br /> alcbRD LD w PRIOR DIST w PRra>z Swrsps a <br /> ice Micigaclaaz -irenaencal Aasaesmene /Cep cal Naaardc" waste nwast t Pipeline Inv.se <br /> cher Lead Agemey site vwy: DISC 6PA PL Site star paality SSG r 'type SSG <br /> DESIGRaT7D MPLOYRR I PROGRAM ELEw:NT a CURAwr STATUS <br /> NOPdSR OF ONIn : SPA INSPR== CODS <br /> Number of TMKS 11aked to the PROGRAM r,CDrd : <br /> BILLnR3 SNI: r, the underrigatd *.nor, operator or agmt c£ 91ae, aekrwvledys that all site sad/ar prb)tee specific <br /> PRS-9= hourly charges associated with Nie facility or activity Will to billed to the Party 1Atncl.fled as rho BILLINGPARTY on <br /> the llaat4rfile Record In r.Lon Pot+. <br /> I ala testify that r have pr.par.d this application and OWC the 'ork to be perforhed will be done in aeaarearlce elth all SAN <br /> cOa:rn Ordinance Codes and 5t4a),dtrr�de, State aamd Federal lave. <br /> APPI.SCART'9 9IONATURB , l / (!. (�+✓'-' . <br /> IV <br /> Manager, Development & Operations <br /> Title: Environment, Health, Safety & ToxicologXca�.r• .Tule 24 1995 <br /> AVTRORITUTIOtt TO RRXZUB INPORMOSICNz In addition to me abs _ When appiltablc, 1, the o.mer, operator or agent of aaae, of <br /> the Property located at the above sire Addreee herehV wthorlx4 the release of any lad all results, gtoteehiical data and/or <br /> environmental/alts yaeeeaiaoC SnforawClon o0 84N JOApUnI COUNTY PUBLIC FffAi.TF? SSRVICDS BNVro^•^R'Wz'a,. gRAL DIVISION as soon as <br /> it Se availablee std at the 04106 Lime !t L provided to me or my repreaene�tivo, <br /> DBADUM VA=: Inmpaecicrrr CVazent �/ / Prior <br /> Pae Amount aaoVnt Paid Pec. of Payment PayranC Type Receipt 7 Check t Reevd By <br /> CONFIDENTIAL <br /> TOTAL P.02 <br />