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'7112006 16;47 9259442y,c TSG PAGE 02 <br /> L1 q'eE?^.tE v- <br /> SAN JoaQunv Com <br /> R � <br /> NVIRo iVTALHEALTHDEr,4ia'r1WTNT <br /> 2 2 2006 304 East Weber Avenue, P Floor, Stockton.CA 95202-2708 / <br /> Tfephurie: (209)468-3420 Fax:(209)464-0138 Web.mvw-1.1[aov.org/ehdz450 <br /> MINT HEALTH <br /> Ndl�it SES 1?'T."�LIC MCOIRDS RELEASE APPLICATION <br /> 'LTi,: <br /> ��5�5c�!C z.,,,�c:=,,� ds• —..,,, <br /> P110NE[1;: �.. ".E. 4�Yr� :—PHONE(2): _FAMIWP: <br /> TENTATIVV AppoiN'rmxT PATE: ..,�The: <br /> (Mona e[tcw 10 bunlasss days from d sto of appilcedon sab;11W-'7MWRO Orty•must be ncsfiMXt <br /> t nt 1")E<,F1.7XM:11€90Af_37.1945.04 FEE(CASH OR CHECK <br /> ltd !F, o.,"RrFFLI,ANf <br /> EnPatronlclaTflrnatiracl: [ILkt0Map--Description: � ( <br /> FILE A DDUV5 EHV USE UNL'r" <br /> 356 = ._-r_ oats .._5ekin5asaecaema_ city <br /> �! ..Y �`,AE+.Y :R Fn.a—N�=rC_ 5lrc!`e'Y•sy u5T _ <br /> .�.v /�t�._ ------ ft'a354 ) . <br /> �'faces►..-, — \ <br /> 4350� A �jI �'3.,�J _F��Je�u.N ,/ S•F�aFctt 'I-, HLJv\i _,.-_ �lanaa \�V <br /> 13 -- <br /> 3 Ib µx C.rle__ fs fi,aa f 1eh . T HVw <br /> 4�(7 �• I .j 19 ..� n (rr . '?._ llsr Unit 6 O <br /> 4 54q, <br /> 46o <br /> amivi TZAR+NNtbice&n'amcv ®MY{�W'fwa�mamwu�esew:ee:mi.+I. <br /> r riw-WI;£;ate R'jilge of ia:bn'nawr+IRN- riested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILER <br /> UROssG."UMV TAIgr(WITI-LeA.Nup SnE¢(eF) 0 HovsmO ABA"ENr 19SOUV WASH FA:[ U TZEt:ICLE <br /> S'S.r^r'N2N swuR'im pfotid1011) E9 POW FACRRY 36wpsirrom <br /> �E,9r;CeaacOL�ag 7ezA1(ItONflOR+NGRLENOYAL) M 00 KENNpE�L <br /> �� IISOAIah' <br /> `H,Z4^yt WAMf GFRIMA SPR CPO"i0xeN RmcX WA£9EwATER'fFE:A'Ndt'A-i�LA' <br /> ' tT.F;:C Pa•TreJ F41?fldTY tR NOTE1MOTv- kPeaiPERTRUMN'AROfCKe31 TC%rr - <br /> - •:S:-o.w af.Gf f::cF.C:iNG POOLWA ',&LAIR]Usr APFLr.AT=$ir?e <br /> 10"PAL WASTE FAMMY tJ OTHER(PLEASE SPEMnl __ •____ <br /> WELL AN9 SE,°Tf4 Fs.R1Ar[�i'FGgRO(�ARE/AYAIWBLE POA[1EV�ER'- N[gNOAY-FRIeAY a:a0IUt1A:e{iF��-v a- F�{C!.4G1 �HMIaAY3._ <br /> 1 fist t.n to tett addm,se,in th'a 9pacg above. Select the types)Of f1ie9 from the list above by chocidrg the apwropriate <br /> hdx(e5n At 4e4'et nee fAe tyre MUST be selected. Fax to(209)464.M 38 Or mail _ P��idrgss Ina��O•��eAddr'u.ras <br /> nP4EL Will ret be,3rcf P4,16-fee addiflonal assistance with file addresses,contact the EHD.A.ppllea*m*received peter <br /> �:f9i, ± Ael;,a Ifrcac-s-;erp the nex�.tr-aslr'eSa day: <br /> will nef[tiy^f:e aW atOt If any EHD f e$exist An appointment for PUAVa A will be COnIftmed approximi"ti,j(JOI <br /> 0eye after recalpt of application. The files WI[I h beld for a maximum of five business days for ravlew. Appe[nnmerAs <br /> 0ould be scheduled awordingly. <br /> '. A file that is actively b-Ing worked on by EHO staff may not be immediately avaiNble fur revie+X, aA new application,lay bA <br /> 1 auh ed W'rl an the fllr=is aw.14,We. <br /> nod ki!lemed.in 4110 aeme"OndWali as released will be mOrgaRl'Xed by EFV steA'at the experse of the lriipa)m <br /> T16 TR law4 by L'te OWE ap;zticant may require a 895.00 deposit prior W review. <br /> EMD USE ONLY �-- <br />