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85/19/2066 09:35 464C EWIRONMEN.AL �L.� <br /> PAGE 01 <br /> 11—DI�41(; ��ENNUONI4RNlr`AL HEALTH]DEPA,�tTMEN�' LC304 Fast Web,',Avenue, 3dF1ooz, Stoolcto CA 9S2 -'�t4phoae:(209)468-3420 Fax:(209)4�-013S'W eb_ 02 ,.705v,'WW'sJgcCv.0r&ebd 0 <br /> ]�U]3LIC CORDS REL' I oAxr: (�lC N H RISASEAPPLICATIO E N VI�?u,d i�EN I H T <br /> �7Z o <br /> aonlzs: g�0 N7�7�r;77?: T a e (u 3 eosn+Fssrncr: ! _ ---_. <br /> Fliot (x)(_2 1.} 3 S'_ U(�1 o cr€Y i rc e SrarE <br /> TENfATTt1,1t� acsau,a 1 2d1 ) <br /> �PPO M-'Mft DATE;tt'bae�*kny to buskom dem from dace of evoaudon railxnkfN. time: <br /> 'Tentwdve ani- be oortCu�ncdl <br /> SOX iUf1 E FfEgU FEE(CASH OR CHECK(CWL.Y)•REQUMT PRtOf'.>vSED IN a E; <br /> SIGNATURE OF APF'LICA.NT DAYS <br /> DATE S'l/b�Q6 <br /> Ltd C1,4V-p tion <br /> F��DDRES3 <br /> shaltftartea EMO USE ONLY <br /> Unit 1 <br /> ''1 i s 1_ 5g o s ve. E] Unit 2 <br /> t�N <br /> s �` _ eUnft ,3 <br /> 7. <br /> 8. _� Unit 4 <br /> ®' 0 Unit 5 <br /> 70. . <br /> ❑ Unlit <br /> Specific Dab.*RA (1f 1) — <br /> � lrlfGrrlrati47n Requested:pr�o�rlt 1 q to P ".X4 1--.._-- <br /> E NWIRol"MENTA.L HEALTH DEPARTMENT FILES <br /> 0 UraorMKOUlto TAAK(W11 C:s�SttU C_op) Q Housuie ALA"jr-tT ❑Salo WA=FAUJTY/YtJir": <br /> tl17ie€t t EAN11P SnE(tiClVlbYb C)FOOD FACILm 0 W x r-T W <br /> C]tiuo 4aou,m�rJt�cttdotm�xutoll +avN-p D MnK E3 DAIRY <br /> �I I�xar Deere IPrf gr=Gt tVslurua 0 tip RMW 0 WAs'X-WATZt Ur-ATURNY PLkra <br /> 0 TiMWMMMEDFACILnY U MermmaTM E3 F1*W xT1tLU fYAMWCHMW.4LToe trs <br /> G7 T'A7T"3CCY P03UMV O PaouBrA 0 LARD U=r4rrmikTow Snu <br /> L71deeOAL WASrt FaCXM L7 OnMR(PLEUe SM <br /> W .AHo StP�rtc PrrrrEtY kEcauxz ARE IWIULAbt£r Revlow-MONDAY44WAY&06 Aa.S:OQes. - amim mo Itoeto.kra <br /> 1. Llst up to ten addressem In the apace above.. Select the type(s)of files <br /> from the list above by che„tdngthe <br /> app€rPriato box(es). at(ems one file type MUST be selected. Fax to(20g)!Ew1 ay mait to dile add��ess <br /> 104100�EO 0b Adder rangts Will not be accepted..for additional assistinee ttd4i'a file addresses oonla�j <br /> the 641t.Applicatione received after 3:00 pm will be proces"d the nW bustnalm clay. <br /> g The END Will notify the npplic 2nt If any EHD flies exist An appointment for review will be confirar tuct <br /> apprt idmatety ten(10)clays after reteipt of application. The filen will be hold for a ma3dmum of five tweiness <br /> days for review. A ppoirdments should be scheduled accordingly. <br /> . A file that ISS aotiYely being worked oti by EHO Staff may not be immediately available for review_ I,new <br /> appWation may bre submitted whon the file Is available'. <br /> 4_ Any file not returned Ira the same condition as released W111 be reorganized by EHO staff at the exponsa of tiie <br /> �appfkanL f=utures file reyie m by the s}atmea applicant may require a$'9$.00 debpoelt prior.to r9vlew, <br /> &Ho 4444 <br /> y91�1�ooa <br /> 10 -39Vd 9Z9096860Z 9Z909E860Z ZZ:60 900Z/61/90 <br />