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OCT-07-2003 TUE 10:59 AM GFTTLER RYAN FAX NO. 7W93218 P. 02 <br /> v-VJi U:ZIAM; <br /> 9312I/2003 89:1q 464 .� :a=6 ss, rasa +r ,i s <br /> ENVIRONMENTAL WEALTH <br /> PAGE 92 <br /> ?AN dUAqULfM%,.uulv't'x llrtvvlltuPtmaht't'A�.l�aAl�'t'�yy;rAK'�'1►1�1�;)y-1• <br /> SERVICE REQUEST <br /> Type ol8nslho,a or prap�y <br /> pAclu ry IC s SERVICE—RE QUE T#Y <br /> Air— '� -0 o 0 7'72-..,, S`K o0 3 - <br /> R/OpRRATOR - <br /> OIL <br /> FACIM HAMS � r" °� ft"KIf PA WAA_a6 I Ts.1131 <br /> SCtE ACRRESs <br /> M 'Or iyrnlllrkQ Aotr m AIrt4►Rnt triad Slte Address) <br /> CtTr ' <br /> STATA zap <br /> PHOIfeN1 <br /> A C2Q W% Kr APN N LANA Um/p rAmm# <br /> 1 [� <br /> PNolrarl� q�,l, 1. <br /> BpS QfSTAiCT ���CdPe <br /> R uEs70R CONTRACTOR 1 SERVICE RE UESTOR <br /> awftse Ngwtt: <br /> cxrcxtf f�Q <br /> IYG.. PltotfEd I,.. <br /> How or Aft.fw ADdms <br /> ` cSt�r J32 !"Axil <br /> 11AAj- i ZIPwvnuff <br /> l <br /> I, tho mdersfgaod property ar bminess o <br /> ncictianxredp that aq site az>dJor protect gWCUlc ENVIRaNMSNTAI.HEALTH DIWART If, dychar or soda iced agent Or tafff!, <br /> Activity wAI bo WIIod to tae or tiny business ne idontiffed oft this form X13'ci�atges associated with this project or <br /> I also ewify that I$ave prepare Qtion and tbat the <br /> COUNTY Ordhmce Codes. nd Wd4,STA WW FEDMtAL IAW k to be pat€otmai WfU fm dans in accardanm with ail$AN JOAQUIN J� <br /> A,PPI+ICANT'$SIGN <br /> P toraTVAusiN"wx ^ DAM. s d I � <br /> Q TiDfi I MANAGaR 13 Crmgft AUTHONZpp AcftfvT� <br /> IM <br /> APPL/ Ni~i:4 oat proof of amrhorkollom le sign is raqu�iye r�� <br /> rak <br /> O :Wheo applkablc.A lite Owner or operRtor of the property located at tho <br /> above site to*0 e, JbAQ Attdtoriee tha toloasa of any and All tv ultfti acetoohniaAl data and/or wvironmcataWjte assessnfnlJt <br /> infbrfnitlau to die SAN doAQU1N CoIMTY$NVIRflNMBNTAL NP.ALTH DEPARTMENT as so s it is avai4ble and at tbo sa i <br /> me it is <br /> tarovidad ro=or o!V noprosatidttive. • that <br /> TYPE OF aIIoM R=i:s=:71 commmm <br /> E <br /> �n 7 20 <br /> �o�Nn <br /> s5(vr s <br /> p CLIC E; 11HEP�TH uNis N <br /> Apt+Rovklf ar: <br /> I:MPLOYFcE�: IDAM } <br /> AafilWtfrp Til: U <br /> ENP�oYEf:t1: DATE: <br /> a7DSNotwceeentpleEea rnaffe�dycanpateu,�: , <br /> Fats Guilt. '' AftIount;Paid <br /> payfaant Type Fb `f Pipit O t! -7a 3 <br /> ,� Iovotcag Chock it <br /> to L Raceiveal By. <br /> &FfiD it8-0'!-OZ8 ' <br /> arfst n <br /> 6-"2 <br /> sElZVrcE RIeQUESr pofrM <br />