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11/17/2006 14:09 916-766-0366 LFR '4.5 51/01 <br /> G° oEfe fEDF_HD hJT.99HR <br /> SAI�JOAQUIN C'ClU7�?'N'Y <br /> ENN/77 ONNIMINTALHEALTH DFUR�RTn ENT <br /> NOV 1 7 2006 304 East Weber.Aveoue,3rd Floor; Stockto r;aA 95262-270 q� <br /> ENVIRONMENT HEALTH Telephone;(269)463-3420 Raz:(209)464-0138 Web:www,sjgov.crgtei. <br /> PERMIT/SERVICES PUBLIC CID ilS RFL,EASE ALPPLTCA�BION <br /> APFL.IrANT: -. <br /> ADDRESS: 5 Tb _ <br /> PHONE(t):�N ,?P `,—,T PnoNE,:):...._` ffiGSSN'.ILk <br /> TENTATIVE*0POINTMENTDATE -_ jep+ _ Tema _Jf�<-_` <br /> (phase alfO;p*-F.D tmzlne^>5 dey°:harm!?at::f epplica0on submittal--"T Sive aa;!y•mNsf�sor _ <br /> 0 CHECK Box TO r?F£FNTE RE?UEST-1, 6.clt FFA(CASH OR CHECK:ONLY i-l?FOUEST PRODS-bacD lt4 J BUSINESS <br /> 6¢O,NATURE OF APPLlt' i i"r DATE /r1ex6 <br /> ? : fr —_. �.. - — <br /> Electronic Information: `i List I] lgR-sp V-aRcriptlon: <br /> MLE Ai5VRE$a j m> Rm EHD USE ONLY <br /> -1 Sireet6 3tLeet Nam .._.._— city -3- F-4 <br /> -- <br /> 2. -- is1 z <br /> 3. <br /> L JLI if 3 <br /> nq <br /> 4.. I w LUUV <br /> —� <br /> Specific Date Range of infornt±ation Requested:From -- <br /> ENVIRONMENTAL HEALTH DEXAR-TIiIIENT FILES r <br /> `-UNDERGROUND TANK(UST)CLES NUF SIZE(LOPI ❑HOi)_S;NO AsATE;wEWi -+-o01tD YL'ASTn PACIU�1'fVEXICLF_ f <br /> OTHER CLEANUF SITE(HO*LOP$ MFOOD FACILITY ❑WASTE TIRE <br /> -UNDERGROUND TANK(MONITORWWREINOVALI - 0 DOG KENNEL ❑DAIRY N <br /> &HAZARDOUS WASTE GENERATOR ' CXICKEN RANCH [�,t�Y;%<TEWATERTREATSEN7 P"ot, <br /> 'fit TIERED FERNcTTED FACIL171 MNo EIJHOTEL .'.i,,Nr t"IiM?ER TRUCl6`�!A^n[i%SEs.`.TL:11 "_ <br /> G TATTOOMODY PIERCING -n POOIISPA #IANO USE APP,[CATION,SITES <br /> `-MEDICAL WASTE FACILITY - ='OTHER(PLEASE SPECIFY)—.--_,,_-_.. .•--.- ----- <br /> WELLANDSEPnCPeoraTRECORDSARE4,VAILASLE FOR REVIEW- M0NDAY-FR1QAY8:0OAN-S:O0PM - EXCLUDING HOLIDAYS. <br /> t. List up to ten addresses Ea the space above. select the type(s)of Was from the list above by checking the ap f ropri to <br /> box(es). At least one talc type MUST be selected- Fax to f208)404•@136 Qe mad to the addro. ,indlmted vE. Ad tress <br /> ranges will not be accep 4d for additional assistance with file addressaa.pontact the,EMU.Applications received:fter <br /> 3:09 pm will be processed the next business da J. <br /> 2. The EHD will noti3y the apWEioant if any EHD fiisa exist. An appointment ftr'r viely v'614 be confiitned approximate'I fin(i0) <br /> days after receipt of applikatlon. The files ivili be hold for a maximum of flue business days dor review. A,opoiTtm:I ti <br /> should be scheduled acceirdingly. - <br /> 3. A file that is actively being worked on by EHD staff may not be irtnediately available for rmiaw- A new application nay be <br /> submitted when the file i-s'avalable`. <br /> 4. Any;Us not raturned in tit';same condition as released will be reoruaniFeW+.by CMD staff.at the expense of the applir ant. <br /> Future file reviews by the:same applicant rare inquire a$95.00 deposit prior tO review. <br /> EHD USE ONLY <br /> — -------'--_. _—.�I <br /> �wi.tE., �tlazaea <br />