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88/19/2883 14:14 . 818-361' 79 LAURA CATTANEO � / PAGE 01 <br /> ENVIRU+IENiAL HEXTH PAGE 11188/19/2883 13:82 4648138 <br /> DAMRECL>�. : - SAN JOAQUIN COUI!i•I'1tr <br /> • EWMONKEPITAL HEALTH D1?ARTKWT <br /> 304 B Webs Ave 3"Floor Stocison.CA 95205 <br /> (2 <br /> AUG 19 [003 <br /> Q09 3 420 Fres (209)464-0138 web:W"-00JWJp!4�a <br /> )468 <br /> i. t cl:lcld i I'c�,l. Ir PUSLIC RECORDS RELEA3$APPLICATION <br /> fl�1�DL1- £hvt�ntit <br /> ANrt �,AVRA CA iCFln�� et,slNN!e87A6iNCY t .y 2— <br /> APPL <br /> _ <br /> AOO C r (' �06L FACZF LE£:• <br /> PMONE `-- J <br /> 7tm�' <br /> TENTATTVE*APPOINTMENT DATE: <br /> r�•�// IPlpsna e11"10 badness d.Y3 from den of•Ppljaaob subrnataQ <br /> 1-�P CNECKBOX TO WCP6DI1L Ra4UEST-.S®S.OO FEE—REQUEST PFIOCReaAD 1N 1eUe1NESa 0A <br /> DATE 1 6� <br /> SIGNATURE OF APPLICANT Dop,.Mwt use Oran <br /> UNIT <br /> Pa.E ADDUnit 1 <br /> itEaB <br /> M1 i <br /> Unit 2 C•�ttGiy,�n <br /> ' C `J <br /> Unit 3 <br /> Unit 4 <br /> 0 Unit 6 <br /> � h <br /> qq v+ <br /> —IFOo N.GIt �RONM AL HEALT4t DEPARTMENT F <br /> IL <br /> ES <br /> P NdUSuN4 AsnSEMEIiT :.. a BOLM W <br /> 2(U OPROROUNDTANK(UST)OLEANIIPSITEXOP) ca Fool)FACRSTY. 1 .....G'O7t1RY <br /> .. .. <br /> [,?�0TttER CLEANUP StM(NON-LOP) n POSE KENN�I." _O PKO�TItiU'TM6Ni PtAHt <br /> tYUNPEROROIINDTANK(MONITORINOfREtdOVAI.) l7 CHICafiN RANCN p_PUMPER MUCWYAR=H;iM TOLCM <br /> p/NAZARDOUS WASTE GENERATOR. ❑ MOT'PLA-40ML, '„ - ..-G LANo USB APPLICATION 3M <br /> d TIERIM PERMITTED FACILITY - P poo"PA <br /> ❑ TATTO01000Y PIERGRNG O .OTHER(Pt3ASE aPRCIFYI <br /> a checking <br /> d��'WasTa FACRrr'/ _ _ tM s eflileairom the list eboY 4Y <br /> 1. <br /> List up to tem addresses in the%;l above a fIIiJST eapaacted. fiat aRb 013a or mail!° <br /> the appropriate bo%{es}. At Ieaet one a P �be�fl� <br /> MMU <br /> dl ated�94Yaa of apPlfeatlon. The files <br /> 2. EHD wlil notify the applicant if any EHD files r than <br /> to sp0) days ft for t�� <br /> approximately five business days but r later than ten vie days comms t*should be scheduled <br /> will be hold for a maximum of five business days for review. Appointment* <br /> accordingly. being worked on by EHD Staff may not be immediately available for review. A new <br /> 3_ A file that Is actively FAD staff a!thePenso <br /> application may be submitted when the fife U available. - hr to review. <br /> 4 Any file nol ntmFuturo tisame <br /> review bytion as released will be tha same APP scant may require reorganized <br /> deposit Wt <br /> of the app ointment dates must be confirmed with EHD staff. <br /> 6. 'TENTATNE app <br /> p pplitatlona received after 3:00 pm will be processed the nsxt blislnese'day. , <br /> TIME: <br /> CONFIRMED APPOINTMENT DATE PHONE FAX 1NRUU f1 DATE CONFIRMED <br /> CONFIRMED REVIEW DATts <br /> yyEp YES <br /> NO <br />