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<br /> +� lei i; plitaCons Wf!I.3a Pcoceysed When Submilled Properly C6mpWed.tis S11re To Slgn The Aapilcat+on.
<br /> titin —�
<br /> APPLICATION
<br /> �r
<br /> (For Nrn-TrEsnefernble,F;e,ocebly.and Suspendeble) E17�'ti,LiE I
<br /> 7� � fW(,;Yi�t;�t�aPt'1�:t�'�Ai_friEA€.Tlf PERMIT
<br /> 4 LIQU!@ WASTE Q _
<br /> 'i y!pllcalit�'�li orpb•rnndo to carry on businnys!n th,cluris+yictto=',ai.pfoa ca.It ;�Joor�uin cel Health Qist:lcl
<br /> E C[ ,t r _ _ _�.Ars=es - 1 �1 —1 _ _ �✓.f_ r� ffi:G 4;
<br /> $;, , • ;ausiness Na.tle't'>UA) r fes/'♦/fi --P--'-l�r,P•.rl_, _ .--_ - 3
<br /> Firm 3artncr5,R;C eSses wnd T I hono Number; -_.v _._ .__• ._. - f�'
<br /> L'Iv,iness Tatephonc No.__1 - . ---.__.._� Emrfgerlcy Telephone NO.
<br /> +Contracter Licer,rw
<br /> rApplicants Name;Print] ll �C- �•1��_+�Q�U r�.1�- _L.s.�� 5
<br /> N 'r Ta'aa3e ohech Appifcable Cre`.ogcry(1-7)and Fill In 11:n fiequir.ld lclOrmat!"
<br /> PUMPER VEHICLE PERMIT iRFGFsrnATION(FOR EACY«'r HICLF.)
<br /> S per July i,__----June 30. 19 -_-- !)ISposas Site! _ ---- - ��- s
<br /> Gasciiption'1�4a! �lr.•CGlor). _..._ __-----. - .__ ----
<br /> CAL.License Renewal
<br /> serial No. __-...._--_..-. __._.-.-..-.-•CAL.Licen:1.!No.
<br /> Capaci4y Gal..Yufeights&kicaau;es No.
<br /> Y Equipmonti".rki!, Addnvss__----__._---- --.__---_�-
<br /> 2. L.f PUMPER PARC?
<br /> ? FO,Ju!y 1, __ J1111s130,
<br /> t` No.of V,_:,icley Stores _- -,_. --- . - _ •? �?
<br /> ` No.of ,pnntica?Toiiyts Stored---_--- - --- - -- I'
<br /> 3• G PERCOLATlk�N TFSi _ t
<br /> R.S.or 1a.C.F No.
<br /> i.S.or P.G.E'.Nsme— --._ - 1'est terimu
<br /> Test Lcjcalior, -- —__- -- e' 1J d
<br /> I SS.rriTitTlO[d PER 1. _ — ' '.: Ir
<br /> v Job Addr ss."•icnttor,_ s�_r,_r_`r_ r1;����<��`��- d��'-- '.�j i.�`j�Q.�•� r.1 X51—f��_ ��t
<br /> 9 � ,.�---�. •
<br /> i. Owner
<br /> . FIEI-D =i S'-EP GE PIT © PACKAGE PLANT
<br /> SEPTIC 1NC ❑ CESSPG['L
<br /> [� FWPAIR ❑ gr-HER #
<br /> ❑ TEMPORARrd� NF--w
<br /> x �PERI�AFGENi Y
<br /> Y- S. © CHEMICAL.TOI1_lc7S "Or July'i,
<br /> r•�
<br /> Disposrrl$1 to
<br /> 6?uipment S!0lege/Cleaning Lccation(s) ..
<br /> NO•01.Tits —___.
<br /> 6. ❑ Where TRE4TWENT PLANT for July i.-Jun[ 3Q,y0 _ - --- -- _
<br /> ere C:ortiTigd
<br /> %. --__
<br /> ,perator Name
<br /> �. Plant Location
<br /> No.L1nIts Se[v:;d
<br /> Plan � ry
<br /> t a0ac4 -. - ---- --- ♦ . L
<br /> 7. ❑.LAUr4DRY For July 1, June 30.19---
<br /> A
<br /> E' StZF:. ❑ Less Than 1.000 Sq.Vt., ❑ tfore Thar. 1,000 Sq. Ft. - --- --_ y
<br /> ❑ DRY CLEANING;,Chemicals Usod/Amountlhlo.
<br /> X� `. 5
<br /> r' 1 hereby ce- that I have a:9pared this application anc1 that!hc work wilt be done it accordance w![h San Jcagilin County
<br /> �!
<br /> ordinances,stale laws,and ruler and rEgulalioLs cr the Sen Joa4LIG LOC81 Hravh 1.)IS:r!ct-
<br /> / �.. / fr
<br /> i 7M
<br /> APPLICANT'S S:GC4ATUREX1 -'4' ' -- - - t
<br /> FOR DEPARTMENT LOSE C1NLY
<br /> REMIT Ii
<br /> Fee tS Due:'� F.'JPIUALLY ❑PiT1 UNIT' 4r PE-A SITE O RA[Sh: J-nue,tII r.R2[[1vEG EY JanuAry 31 ( Jut) 1 i..^.•:Salvnci P.Y 1UIY 35 11!
<br /> .^- — RILLSN4 nT:iv!ITTAhrr AMp
<br /> I S UN7 DL'n. CHECKED
<br /> u f �fi i
<br /> hACC - EMPLANnr10N' - DATES Ph7F, ° FtEMI7TF,��
<br /> >i LESS
<br /> PLUS
<br /> AEt1At TY
<br /> ii . erne;;
<br /> i.a mlt�:;• —iu:csrr.�ISaio :7eTl y trlv::-M� w 1:
<br /> F' .5 rat C -••••— )sir- F,LcnIT HAZCI,T0t1 AVE.,P.O.era 2CG>; 9'{OCt[TC•N.Y E
<br /> -Kir.'._ `�� L--�- AAiLICkYY�Fli!Tl1f1N AL:.C;rFf3H YO: ENv:pl:Ni•A.^_NTAL kLALTH F'r�1�IRl.lSf:i11'IC¢S 1Pf�1 Y. ,-..s. � �•
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