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FROM NCA En'd i ronrncn t .i . PHUNE NO. : 209 365 42-J . rlar'. 1d 2W'-J1 -JJ:LJ'1Pf•i NL <br /> SAN JOAQUIN COUNTYPU13UC HEALTii SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> / '0` 3301 EA-TYJERER AVENUE.THRn Rzop <br /> :TtJ <br /> CICTOM CA 2a= I 0�4 2.4v <br /> PLIBUC RECORDREi AEF APPL1CtATIQ)V <br /> CscAHr Chi_ P WG1r aamaaauv P,4GtL O. hn�n>~r �ON_a �45soc . <br /> AnnRast Z u IV , t hD Uma h ! l Fl ra E UD t7 1a c•/� Q 5 <br /> PrtnliG 2 ,-eco-.1- - 6-10 t n �.. _ L0q— ,3Lp6t — 4.22.8 <br /> TEFITjiTlv�'AP?OItdTMLHTt14�f`�arcnr ,ZdOj ,,� g :30 1}t''l. . <br /> fFtnase acv.7 to t[t awuaa.a..tcrp iea<n mu at a <br /> ppU+CnNaa aonmlairl <br /> CNECKH4Y TO F.'.Pt'Ptr4?_`ftEQU7:a'r+AE.OG F714 xnr.�/ * Qi3BtISWF;a GAYS ��� � £ <br /> SIGNATURE OF a FPLICANT W� <br /> DATE � <br /> At I to a-1-nc cps AooHtaa <br /> A t S so. � 3-Cr 5't=. r �c11 Son 11: 1. $<I+op �.���. 7 • e�l� _ . <br /> 65 Sp'o Lincalh5l-. Sync �P?knicF LuJ[ ' a/rS� 3Sd7 <br /> i 1 2Li .Sa. 1-i t n S. . Dot'k a C; 3S.210 � <br /> I lap, z 6 3y ar, <br /> q -tog 3s�to <br /> W C_ -e 3SaL , <br /> Et1VIRCHUMTAI.MALTH DIVISION RIZ } <br /> tltd'O4ABRUUHb YAs7R IUszl GL4AA:JP sris{ttlPl 8 � <br /> HQUWW ARUMMC 9 WA m F <br /> HT <br /> �OT.$.R C1.EJ.71[iP&Ii'Z<fltt7tld.4P} Q FOM PAC=W Q so'.aII LYALTE VEHICLE <br /> 1r=r GiiGttRGI TAtdK fP6a7taYD4tlMNfit2fOYAL} Q ooGH Q IVJRY <br /> HAZARbQUSVaAaTIISi`.MFAT= a CKUNMN RANCH M rrta'{HrATUFN'r PLANT <br /> Tuakrm rt'!nmalw FACPXI-c C, mmFA arm ❑ PUMPER TRUCKMARULCHFlI Sffi1..SP' <br /> D <br /> TATTocraoryputit=0 cr »l3FA n Wal USEAaFt]r1-nW&W U <br /> C atE=CALWAG=FAM= Pilm1cVVA1-m2..- STw Q UYHEA(PILaA'l<SPECCFr AH6121 <br /> I. Uat up to ta:r nettra"im in the space abeva. 8el�t it:a types}of ides tram the Ilst above by chucking <br /> Uw approprlma oux(es). At tsnat ono faa typo MUST be ssleetAtL Fax to{209)454.11136 ama0(a lltr_ <br /> siddrnaaincf uaw altma <br /> 2 HtfD watt notify the aFPUccrit 1f any MW Rias exist An appointin"for Toviaw WW be cbnfrrmcd <br /> apprttxBllStaly five buslnass days flat no tater than tan(10) Bayo after receipt of appOcaUon. The Silas <br /> will be held for a maxim=of five buaitmsz dxo for review. Appaintmeats should be scheduled <br /> a�Cl+rgty. <br /> 3 A Ms that Is a c4vety being vrarxed on by,i;f0 atL"may not be immaCiafaly avaitabla for ra Aw. A new <br /> application map be submittad wlwa the fila 1s aVt UWD. <br /> 4. Any Site not retwz<ed In the Rarnc caadlliorr e9 roicasad wni bn marganixed tsy DM staff at the Q3t{Wnae <br /> of the applicant. Futtso filar review$try Ulm sanre sppticam may requite a 570.00 tiopasit prior to renew. <br /> 5. 7 EP ATIVE aryrlofntmant"Ina mUat be c0tdimm4 with EHD.Graff. <br /> fi Applisatiana sa Q'Vad aftat 3=Pm"'it be processed tre next buAlneas tray. <br /> CONFiR ED APPOW MI24T DATE TIMJlE. <br /> OATS CONFIRMED <br /> ! PHONE FAX INITIALS <br /> R1=Vif=WEO YES NO <br /> REVIEW pg7E <br /> U .moi <br />