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•I L I�..LIYL._ <br /> i IU 7.t9 P,02 <br /> JUN SAN JOi%QUIN COUN-f'ypUEILIC H <br /> 1 8, 1001 tAl_TH SERVICFS <br /> E V1RDl�IMEN7AU I-t1 ALTH DIVISION <br /> ENVIF;UiIi ,,: :;i EAST WESER AVENUE,TR[Ra FLOOR <br /> PERP 1 i Ti;.E: 3-MCK-ON CA 95z02 q z <br /> Pi1f3LiC" (209)468-3420 <br /> ;MCORDS RELEASEAPPLjCATIOf�! <br /> '+APPLICANT Iw ? . <br /> ADQRESS F-!� 6l1SINE951AGENLY <br /> eCRPHONE. -fir <br /> FACSIMILE <br /> 7'ENTA7IVt~,zPPolnrafENYD.itE a f' �/ <br /> .(Plcaso pi�c 7.1010 buslne¢sTIME ��+C9C7/ 'rr7 <br /> • / �, /� "Mdale of aPpki uon aubmittaU <br /> CHECK 90X TO EXPEDITE REgVE57- 7 zleN// o J2 <br /> -00 FEE— S ROG EDI BUSINESS DAYS <br /> -SIGNA,TUFE OF APPI..ICANT � _ <br /> DATE �{ <br /> FILE AOOREsS! <br /> 7Hc4 SIDE EHD sYAFP YsE owy <br /> �- PROGRAM ELFUV1F1I7S SEARCH O <br /> l <br /> EWIRONMENTAL HEALTIf <br /> UNDERDIVISION F1LE5 <br /> O <br /> q D TANK N�CL[ANUP^un;E(LOP) C'J.HOUSING ABATEMENT <br /> ❑ THER CLEANCLEANUP$[ (NON-LOP) <br /> +UNDERGROUND TANK ❑ FOOD FACKM ❑ SOLID WASTE FACILfTY <br /> O NA?ARDOUS WAS rz GIENEER yTORR � ) ❑ DOG KENNEL 0 SOLID WAStEvEHICLE <br /> ❑ ne to PERMITTED FACILRY ❑ CNICKEN RANCH DAIRY <br /> ❑ TATTOPI&ODY PEIRCW(i ❑ mOrE ROTEL ❑ PKC,TREATpAENY FLgN7. <br /> ❑ MEDICAL WASTE FACILITY O P004sPA O PUMPER TRUCK rARWGHEM TOII.ECS <br /> ❑ PU84G WATER SY,S-i7;,81 4 4X MER(PLEASE E X pyE) <br /> 1 4st up to ten addresses in tiles ace above. S <br /> the appropriate"X(eS). At i le SPRae file Oleot the type(s) Of files from the list above by chocking <br /> ad.SLlss indicated afv type MUST be selected_ Fa� t the list above or�� mail� ki <br /> 2 EMD will notifythe ap iZ <br /> approximately appl,cant if any EHD fflcS !exist An appointment for review will be <br /> y ttve business.da s but no later than ten 10 days conflnned <br /> Will be held fora maximum Of five bus nes ( y after receipt Of application. <br /> accordingly. I s days for review. Appointments shoWbe gcedu7ed fries <br /> 3. A file that, actNely being Y-prked on b <br /> aAyfile ion may be submittBd when the file is HDM may <br /> not be immediately available for review_ q new <br /> 4' Any fila not returned in the ffime en the as r _ <br /> of the aPPlicanL Future file 23the1Co di the Same da-soda ill be �rgadIzed by EHO staff at the expense <br /> s. *TENTATIVE <br /> 5• _ ghPRlntMent dates must be confirmed with EHD Staff, a$87.00 deposit prtor to review. <br /> Applications received after X00 PM will be processed the next business day_. <br /> 3ONFIRMED APPOINTMENT DATE' <br /> pA•tE CONFIRMED Tlfdl= <br /> PHONE FAX INITIALS <br /> YE <br /> H OI 71 0 AOS NO - - -'�--_ <br /> REVIEW DATE <br /> Tf1Tol C a-, <br />