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� 1 <br /> `rE 25' 05(FR 1) 17�02 Vt WR, INC. TEI, '69622679 � z <br /> �1 /?F]415 -1 r: 06 464013B HEAL--! H PA-0E 'Ell <br /> E�:-�11 <br /> Fru ILIU43 fr LAVIMCM <br /> F4 ' `�';'i��10SAN JOAQUIN COUNTY 1Y4 FFFIII <br /> '7I_ ' `'/ ` ENVIRONMENTAL HEALTH DEPARTMiNT <br /> 304 Fast Weber Avenue 3r1 FIQQr, Stor%toii CA 95262-2708 E <br /> I` F- �� Telephone: (209)469-3420 Fax: (209)464-0139 Web www.�igov.org/chd <br />► ENV[ 30 <br /> nOl�fe�_a�7 fEt'� ` P 'j t <br /> pF�"vliT/SE i STN PUBLIC RECORD$ RELEASE A,P 11CATION <br /> APPLICANT; , • �► 0US1N1~SS1AGEN8! Y: <br /> ADPRESS:-- 71 j? �'{ �Gru f , $u r rI I <br /> -S�O E ? FACSIMILE: 9I{� <br /> PHONE(tI H N ISI <br /> TENTATIVE*APPOINTMENT PATS: i Timv: <br /> (oleasw allow 10 Isuslnese days from date of appllcat(on submitul-,Tewalive OHIV-must bo conf(rmed) 11 <br /> M CHF-CK J30X TO F-XPEWTC RF-GUEST-$97,00 FEC(CASH OR CHECK QNI_YI—RE QUI:STIPROCE SSP,P IN S BUSINESS DAYS I <br /> SIGNATURE OF APPLICANT - RATE <br /> UNIT PESTRISAlt 3 }tlrlit 4� nit 5 Unit q� ❑ Other(aloctronlcllistslmaps) <br /> JITION �uitiXUrill: <br /> FILE ApG1R�SS `' ° RHO USE ONLY <br /> Street# 5troct NamA ..,_ pcIty_ <br /> 2• 'L t341 .fir r '7 . <br /> 3. X- <br /> A <br /> 14. I <br /> . } <br /> I <br /> I' AIS _ <br /> Specific Date flange of Information Requested: From <br /> ENViRONMENTAI-HEA),TH PEPARTMI?NT FiL'rIES i <br /> ` (G SOLID WAVE:p&ciLITYNEK(CLE <br /> HQU6ING AI;ATEMENY i} U WASTE TIME r <br /> UHQ12R1=UNV SINK(UST)CLEANUP SITE(I-OP) O Facp FAMI-IlY ' E'?OAINY <br /> L.0 OTHER CLEANUP SITZ:(NON-6aP) M pqq KENN9� <br /> t1NQCROROUN4 TANK(11 Ot4lToRINGIRPMOVAL) �j G�44�KEN RAN�N -yd WAs-rEWATCR TA pTMENT PLANT <br /> IN K�ARpnusWAaYEG5NERATaR r�MprallHaTCL I Pu>HPERTpucK11'AAnrcneMT¢II,FTs <br /> 'K I IERgp PVFtMITTED FACILITY •Q PoatMPA Q j ANR U5E aPP41CATION SiTDG <br /> 0 TATT00114 IM PIERrING F-I QT�ER(PLEASP 9A6CIEYl l! <br /> WMEDICAL WASTE FACILITY <br /> WeLL AND SEPTIC Pr`1zMIT f;ECpAp6 ARE�►VAILAt3Le Frit REVIEW <br /> - ENONpAY-1 RIIJAY iI:QO A ^3:Oe P at Bove by GhR k n the <br /> 11 List tip to ten addrErsse$in the spats attove, Select the type(s)of, frim the list <br /> i <br /> appropriate <br /> box(es), A <br /> t least one I11e ah MUST be selected, x to 09 B -0 3 a ail to the address <br /> dress ranges will rat fie accepted�tar additional assistance g�dad frla addresses, <br /> cnntact <br /> indlca�edj� Ad will be processed tha next a } <br /> }i0,A llcatiOnT1 received after ;go pm p trriant far, ravloW wlll be confirmed <br /> tho F- pP Ana Rift ve usine5s <br /> II �• The EHD Will notify the applicant if airy PHP fyloa exl&t PA <br /> a roxlmatsly ten (ifs)days after receipt of apppllsacnordgnglywEll he held Tor a maximum Of fi I <br /> Pp A olntm nts should be scheduled <br /> days for review. pp a available for revi@�N� Anew <br /> 3. A file that Is actively being worked on by 9HI3 staff may not be ImfrtsdiatelY ' <br /> n <br /> may he submitted v+hen the file I13 available. rfanized by I- view, <br /> staff at the expenan of the <br /> applicatic� y as aioesed will btu t'es� S to review. <br /> n r t prior 4. Any file not returned In the sem <br /> E:conditl4 0�de osl p �---- <br /> applicant, <br /> Future file reYlews py the safris applicant may require a y9�•0 P <br /> ...•�— -rte II ��` ` <br /> ENo 4e•D7•De6 <br /> 11:13iD1 iy I` <br /> I) � <br />