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12/10/2004 16:56 1666° 329 RYAN & FRIG PAGE 02 <br /> �d 12/10/2004 15:51 4138 ETNIR01•fvt<NlAL TH PAGE 01 <br /> E:10 LOG NUMBER <br /> DgrE RF(3MVFD SAN,TOA,QtTXN COUN'. Y <br /> o <br /> 1t1MOMME1V'1'Ax.MALTHDEP.ARIMENI <br /> n,I r•�_ � ) 304 B Weber Ave 3rd Floor Stocktoq CA 95205 <br /> DEC 10 2004 (249)4610420 Fax:(209)464.0135 Web:WwW,C*-sats joaclnin•caus/ehd <br /> EMIR ih 1,i F' r I <br /> pITBI.IC gECO"S IXLtASE A•KPLICAUICIN <br /> PERK,H S.,_APPUGXfin. (►1 IRUSMSSIAOENcr: <br /> -� OoJcsu1. oD <br /> ADD= <br /> PE,GN�: a - is FACS <br /> TENTATIWAPPowtMSHTDATt: lit ( T ' <br /> ukase allow 10 basins days from data of appecavon cabmm li <br /> CHECK 60X TO D3`EE0rrt REQUE $93.00 M—MQUC:ST PROCFSSILP IN a BUSINESS DAYS ' <br /> DATE <br /> IGNATURE OF APPLICANT DapsrimerK Use Omy <br /> UNIT <br /> Fn-� DREss <br /> Or 0 Unit T f7� <br /> and z <br /> e. Unit 4 <br /> r. <br /> e. [] unit 5 <br /> w. ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 NOVsatG ABATEMENT O&oLtD WASTE FACKMY <br /> S(SMtDERGRouN0 TANK(UST)CLEAHVP SITE(LOP) 0 FOOD FACILITY O SOLID WASTE VEHICLE <br /> 6{OTHER CLEAHUp SITE(NON-LOP) MOVAI.I ❑ n0(•1�7HEL ❑ DAIRY <br /> WUNDEROROVND TANK VONIT'DW O PKO TREATMENT PLANT <br /> a HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑�PER T'RBCIVYARb1CHEM TOILETS <br /> A TIERED PERMITTED FACn.LTY ❑ MOTELFROTEL ; LAND USn APPLICATION SPIES <br /> O <br /> 13 TATTOOMWY PMRCI 0TWR(M <br /> O 0711FµiPLeASE SpEQI <br /> O MEDICALWASTErACILRYthe list above py checking <br /> 't. List up to ten addresses In the space above- Select the type(s) <br /> of files from <br /> the appropriate box(es)- At least one file type MUST be,selected. Fax to209 Q -_0138 ar a the <br /> I 1 ted above. <br /> 2_ Flfq will Hour•/the applicant{f any END files exist te appointment for revi ctv Wi91 be Colon. <br /> apprmdtnately five business days but no later than ten 110)days altar rents s of should <br /> be!ache ul The file <br /> will be held for a maximum of five business days for review- Appolrttments should be scheduled <br /> acoordingly. worked op by EHD staff may not be lmmedlately available for review. A new <br /> 3• A file that is actively being <br /> application,maybe submitted when the file is available. <br /> a. Any file not returned In the same rondiuon as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a 593• <br /> D staff.adates e <br /> g, Applications received after 300 pm will bo probesed the next business day. it <br /> • 'ti'" m rntj'.•.- <br /> GNFIFtINI 'i?u?P'diiilMENpai�E .MIME„ .n " : -+., <br /> D.�jpHoNE . FAX'' ' ` ' JKfPidl <br /> `�1f��CONFIt21NE :'.;.' ' � ' <br /> tiEVIEYYED NL' 'YES NO REVIEW DATE. ' <br />