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02115/2005 16:29 2096342883 FEDEXKINKCIS PAGE 02/02 <br /> DATE RECEMID � END LOQ NUMEFR <br /> -.u SAN JOA9tJW COUN'1'X <br /> E - <br /> W f ENviRON NTAL REALTI�DEPARTMENT <br /> 344 FzA Webef Avmue,P Floor,Stncktou,CA 95202-2708 <br /> -7 <br /> FER <br /> 005 Tckpboac:(209)468-3420 Fay: (209)464-0138 web:WWW,sjgvY-oredd <br /> E r PMUC REC0)DS RELF.A9E APPUCArn0N -- . <br /> PkW' bWWRVM'' " Vavx Mk-.t .. eusurr stnca�rrcY• k L cAVti f <br /> ADDRESS: 2,'-f-0 \jtNLa r U C c�rl�ac G4 I `IS `E3Z <br /> P"mm m; C�6 't PHo�(2): 2sso} (-'C?9 acMM <br /> TENTATIVE1Ap mTrawoA7l2.• `�.f ��` ; 491-.10 <br /> (Pkwiae aaw 10 bWnen days from deft or«ppucaeon mAHI imai-"T:iartke only_must be ounu m d) <br /> ❑ CHeCK 130X TO MMEDITE RMMST-1:93.00 FlM MASH OR CHECK ONLY)•RMUEW PROCE3MiN 3 MM DAYS <br /> SIGNATURE OF APPUCANt _ i1-�y�- i .. DATE <br /> UMT D15TRMV110N I,1 Unit i D UM12 D Urrit Z O Urst 4 UNt 6 Q Unit$ 13 Other(e10dMrw0iaWMMF-b) <br /> FILE ADDRESS 1 . J EHD USE ONLY <br /> 8641tt 11 Slrtat Name My <br /> ti. '�� Ulo,.,n 4o,n � •�'.:�fir ?� 3�n <br /> 9. 7zll W 's„ '<3 i'r`e <br /> � <br /> SIecift Data ltarlse oT infammcoa Requested:from i to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> P(UNOERDMM TANK(1197)CLMUPSITE(L0P) L]Homm AsATmwNT 0 Sour WASTE FActtmMaaci.E <br /> C3 OTI.=CLEMW 3"UION-I m 0 FOW FA "tY 0 WAWE TME , <br /> Ct LkMMROLM TANK(MONrrORMK111MMOVAL) O DOG Kew - 17[W" <br /> MAYIOUSWRS7Ei#g r�1lTOR"-"""' "`-, Q - <br />---- --�'- - 3 - _ _ WA9T�1Af4 TMtE�IT.PI./W7 <br /> A - - - <br /> PtpteYSEO'F�tCe ,fig <br /> E3 YATTODAWDY Pe ACM fl POOLSm d Low Use APr66kfK)i teats <br /> ©ME1CAL WAs1E FAaLny O OTHER(PLr;AM SPBr, 1t) <br /> W04-AW SQnC PER IT IRECOM4 ARE AVA ML E FOR REVIEW FMAY 8:04 AM-6MPM • Ex=U0M HOinAYB <br /> 1. ust up tO tM addresses in the space above. Select the types)of files frons the list above by cheMng am <br /> appraprlata box(es). At tagst one file type.MUST be selected.I Fax Io 12014§1.039 or mail to the address <br /> Dedicated above. Address ranges wit[not be accepted—for additimal assistance With file addresses ontact <br /> the EHD,Appllcatiorrs reodved atter 3:00 pm will be proc:esa�etre next businms day. `c <br /> 2. The EHD will notify the applicant if any EHD files exist. An aP�ntmant fo+nsviaw wiN be eoofirmod <br /> apprmMnaM*ten(10)days OW receipt of appllco*m. The files will be Reid for a me iMum of Live business <br /> days for review-. Appoinhner is stiould be scheduled accordiriyly. <br /> 3. A file that is actively being v priced on by EHD staff may not ba imimedia:Lety avaitaime for review. A new <br /> 3011catlon may be submitted when the file Is available. <br /> 4. Any file riot returned in the same condition as releosed will bdfir arganiaed by Etio stadf at tr1a WpNm of the <br /> applicant Future file reviews by the same appli=nt rrlay r qu.re a$93.00 deposit prior t4 mvlew. <br /> i <br /> �o�s-o�vos i J <br /> E 1 <br /> i <br /> I <br /> v I <br /> I <br /> s � <br />