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FROi'1 hU.H Eng.,i ror�rnFr�1:.3.1 F'HLhdE HO. 20'9 ---Gy 422' Ju <br /> SANWQLJIN COUNTYPU13L.IC HEALTH SA <br /> CE{Lj�L F� <br /> F::NVIRtONRe9>,;,WAL HEALTH DIVISION a <br /> JUN 1 9 <br /> 304 EAST WR AvENTm(w FLOOR <br /> IEtF. 2000 <br /> STOCIXTON DA 90202 <br /> (205)d ENVIRONMENT HEALTH <br /> Pi. SUS RECORDS RELEASE APPUCATION PERMIT/SERVICES <br /> A-!E SCS G . <br /> ADDRESS LL> N1, (+D U5 I-0 N L A rJ L C7 + G ('I <br /> PHONE 2Dq_6U-A- - t3-1-0 1 — PAC,%Mf LE 2-Dq " .SSP M 4•Z�C� <br /> TE jTAT1VE*APP0,IXTME'NrUATE THAE <br /> 0439"vve 7 tri to lk I0 "Gays fiarfl cats W Subf,%juaU <br /> II C:NPCK BOX TO EXPr] ITP RZQ1J*ZT-37a=Pe-0-19--QIIEST PR0CEsbm IN 1 allnMa CAPS <br /> SIGNATURE OF APPUCANT C���{/t� 'r� �k— DATE'. <br /> • FILEA=RM <br /> V-J <br /> PF v- <br /> 1 7 vl <br /> /1 l <br /> 4 � <br /> j <br /> ENViRMAENTAL HEALTH DZVL N FLLU <br /> V L'KDEffaROUND TANK(UST?CLZAWJP 7tM{LCR►I Q HO"M AGATVANT 0 3oLD WASTE PAQ&M <br /> OTHER CLBAN UP SrM(l0tiAX97) C FOW PAC&M Q S0.10 MCAUM VEHICLE <br /> UmUERGAC) ND TAOiK AL4 C Odi'xEmNa Q DJNLY <br /> IiALAMMUS WATT??'C.0dERttTQX Q Cwt!RAHM D Pl CI TREATIa UT PL AW <br /> ❑ TI8)<l01:1t um,I PACU I T a UovamamL CI PUMPER TMJCXIYAOCWI=il'ZK'rC .ETS <br /> Q TATT04MCI)yq i4W0 a POOLMA Q t.AMUSEAPPLtCATIONSR'P,S <br /> G it WICALWAM rACiIM Q Ptg=WATER srsTEM ❑ OTHEtt IPt.FA6E SPECS"ARUM <br /> -i. Llat up to tan Addrascax in tt*spaaa nbove, swat#the type(s)of um from me list awvo 17y chacmag <br /> tie ztppropi-iata box(")- At least one file type MUST be esioCWd. EC t (lus)4.r„-0238 of MzQ to the <br /> 3jisindimuz abmca. <br /> 2 END wifl notity the* !I;-.ant If Uy EKD files exult. An appointmeat for review will iso onnfir-ed <br /> appr=Lnately fte business days but no!afar than tan(10)days 4w recciptzf applitatlon. The flies <br /> will ba hold for a rnaxim=of five business dgys for review. A ptgn ttsants should Is:scheduled <br /> accy,. - <br /> 3_ A M that la�itveiy�hoh7q workad on tsy ENO staff may not ba Inunu iiataiy avallabta Tor ravinw. A now <br /> &PPtIcaticn n-my be et bmktsd whys the file is avagbio, <br /> Q, Any file not rtisurrAd In the tisane candition asp relvaaed will he rrorganl3md by EM statt at the expcnve <br /> of the epplkAstt. Futuro fila reviews W file soma aWiit ant may require a 478.00 deposlt prior to rewsw. <br /> 5- "Ti:l+l'fATIVE appaintTxmt datas must be acntinrtad udlh EHO staff. <br /> 6• Applicatiqua mueWGd agar 2,00 pm will be procssa*d tnw next buainsea day. <br /> jCONFIRMED APptNPITZdIENT DATE <br /> GATE COHFIg?4= MOM; FAX 1lcIMALS <br /> I ViEYYf�3} YES NO REVIEW DATE <br /> TML P.01 <br />