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YJ{U'J.�kLrlrv4i <br /> �ROL A'LY OGES <br /> � <br /> a 09'13 ri <br /> , .«. .. _. <br /> LIC <br /> Sp � J� <br /> UN COUNTYALTH o <br /> V S10" <br /> �J �iRoKMeNTpN 'iIRtaFLOOR <br /> a Ep9T W�ER DSU <br /> STOCKY rA 95202 a <br /> 1� <br /> 0 01 (209)w-3420 _ <br /> ' L[C REX, DS RELEASE AFp�[CAT�4 c�c . <br /> ALI H PUS - � <br /> t J I CA BUSINZ SSIAGENDY <br /> Y^ r, <br /> tic <br /> po <br /> maw �r) ,Y it�Y1' ( 0,Z . s <br /> °'fir✓..� ADDRI±SS r FACSI <br /> P - Icadaa suDmlt�I} <br /> 'TENTATIVE*APPOINT'MI INTDA-M s from date of appl <br /> t(�yax g;Ys 7 tQ f o business 310/ <br /> 8 fill P1"E-RE�l Eg-TPROS$EP 1N 3�U5[N>='SSS DAYSDATE <br /> -/ I <br /> Cxf C SOX TO�pFCDfTE RECLUEsT Sr / <br /> 5}GNAT FSE OF APPLICANT <br /> Tl f 81DE Ert>3 STAFF USE ONLY <br /> pRi?GR EL�MEiITS SEARCK <br /> ME A00RESS <br /> 3S� _27• v <br /> r'� I � <br /> je to m - — �r t <br /> _3 3 s a s (P <br /> g,5 <br /> 6NV[RQNMEIII HEALT[•i biYtS[oPt FILES Ly <br /> P SQLlgld/A TE FACIUTY <br /> OP "OU ABAT0MENT ❑ OLUJ WASTG VEHICL, <br /> UNDE RoLgOTANK(UST} ANUPSIT�(LOP) d pQOD FACtLTTY CI DA1R'Y <br /> lsS CITHEFi CL.EAI IfP SITE(PION-LOP) o DQG Kt NIIU- Tn pKG IMATFA�Nf ALAIrr <br /> $1 UIIDEF�Otit7UfdbTANK(M0KUQRICIGlIZL>S10YAL} 0 CHiCKL+t3 RAHGH 0 PUMPER TRUCY1TAKDICHEM TOtJ 1=T5 <br /> N��ppUfi WASTE GEN(�T2p,TOR p MOTE,LJt(OTr1 ❑ LAl{D US>*APPUGATIdt{SITES <br /> TI KE pER�fIfT_t7 FACILITY ❑ pQOL/SPA p OTHER{PLEASR SPECIFY A6UYE) <br /> 19 <br /> Za TATTabtEODY P>=.IRCING tl FU9LIC WATER$Y-S Chea irig <br /> 0 MEDiCALyYASTE FA,clf.1 of files hem t11 list $ rbrnai o tl�e <br /> to ton addresses in the space above. MU57 be sepject thep(aected, Fax X09 <br /> 1. List UP es At least one file tyP <br /> the appropriate box( } <br /> a esu; ,�- f•ati abav�. intrrterst flan review will f!4�nf]rT,lThB f][a5 <br /> []cant if aiy EHD files exist +� tOp�da s zlfter reoHipt Qf aPp[[catlon, <br /> 2 EHp will notify the app Is but no later f[tian ten( ) y <br /> approximately flus buglness day ointments should be scheduled <br /> will be held far 4 ft]axltf►um of five business days for review, aPp ava'slablo for review. A new <br /> accordiflgly. ff may not be}r„rrtgdiatsly <br /> 3• A file that is actfvetY being worked at+by EMP s� Y <br /> alypilcatit�rt msy be rul5mitted whin the file Is avail;Itbte. by,E}{p staff at the eXp9n9$ <br /> le not returned in the same condtt[on as releEmcd ibe rggUlre a S78.00 depvalt prior tv revf8w. <br /> 4. Any the same applicant <br /> of the appticer+t t"uture tl[e review fsY <br /> r *TENTATIVE appointment dates rnu5t be cor<i'armns d tbg next lou]rless day <br /> 6• Applications received aftbf 3:00 ptrt Will Fie p <br /> 3lME <br /> i GQNF7EI� APPCIINTMENT DATE INITIALS <br /> I PHONE FAX <br /> DATE�pNFtPtaED <br /> Ft1=VlEV1�1^E� <br /> NO REVIEW DATE <br /> YES <br /> TOTAL P.e2 <br /> 00 14 �� . <br />