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ENVIRONMENTAL HEALTH PAGE 01 <br /> 0t. 04 _14'50 4640138 _ hMU LVU numvaR <br /> >,. DD Sart JOA.QUIN COUNTY <br /> Er1VIRaNTAVAL�ALTU p�'p�7MMNT <br /> MAY 1 1 2004 304 E Weber Ave 3 Floor Stocktooz>s CA 9S205 quip-ca.us/ehd 3 <br /> ENVIRONPAEi 9MF 3420 Fax' (209)464-0138 Web: <br /> PERI 11T/SERVICES kiJB.LIC RECORDS REL' AppLICA.'I'IQN <br /> { �') <br /> Ti>1 ;USINFSSIAGENCY' q�/- <br /> APPLICANS: SV k 5� t /k (A- I mag Z <br /> 3'1� (a r ! <br /> ? pflDRESS: �2 FACSWL.Es 0— —(0-400 <br /> LPHONE' 11 t1fPd��—Time• O� <br /> f 00Cr� <br /> TENTATivi='`w po ll,i p-NT DATE: <br /> bus <br /> irsess days frafromdata of applICZtJon submlttaq <br /> (Please allow 1G <br /> ❑ CHECK DOX TO EypEDRE RE4UEST•593-40 PEE <br /> ""REQUEST PROCESSED IN 3 6USINESS DAYS � <br /> DATE ! Af <br /> peparkmCttt Use only <br /> UI <br /> SIGNATURE OF APPLICAN tT <br /> FILE ADDRESS it 1!n"I <br /> fol 5. w-1 56 <br /> Unit 2 <br /> i. c), <br /> �^ <br /> 3. �°�' W a 5 r, U � Unit 3 <br /> Unit 4 <br /> e 0 <br /> p, Surat unit 5 <br /> & 9eee! <br /> 9. Street <br /> 70. Sunt <br /> DEPARTMEt�'T FlL>+S <br /> ENVIRONMI`NTAL HEALTH ❑ SOLID WAST)"FACILITY <br /> EAPiUP SITE(LOP1 ❑ HOUSW6 ABATEMENT ❑ SOL.IC?WASTE VEHICLE <br /> UNDERGROUND TANK(ON�OP) ❑ FObti FACILrrY O DAUV <br /> OTHER CLEANUP SITE MONITORING MOVAL) d DOG KENNEL ❑ PKG TREATMENT PLAIdOHPJA TOILETS <br /> UNDERGROUND TANK(MVI ❑ CHICKEN RANCH p PppER TRUCKIYA4YD <br /> f- HAZARQouS WASTE GENERATOR E3 MOTELIHOTEL O LAND USE APPLICATION SITES <br /> O 'n5REA PS.RMI7TEP FACK-ITY ❑ po4u9PA SPECIFY) <br /> 1�❑ TATIOOIBODY PTFJZC[NG 0 OTHER(PLEASE cheCVing <br /> o MEDICAL WASTE FACILM Select the types)of files from the ttst above by <br /> to ten addresses to the space at>ovc•e MUST be selected. Fax to ZD9 464-0'138 or mail to the <br /> 1 List up es At least one file tYP <br /> the apPI`003te box( }- <br /> address Indicated above. Et{p files exist An appointment for review"111 bit ationl The files <br /> t a licant if any •;p days after receipt Qf app <br /> Z. E4�p it notify pP Appointments should be tion' led <br /> approximately five business days but no ss d than ten( ) <br /> will be hold for a MaxlmUln of fire business days for review' APP availabte for review. A new <br /> accordingly. en by ENd staff may not be immediately <br /> 3. A file that is actively being Wv°rked. t sit clot to review <br /> se <br /> application may be submitted when the file is available. limay require a$93.00 dap P <br /> In the same caTiditlon as released will be reorganised by EHD staff at the o r e ie <br /> 4. Any fie not returned the$Zama applicant <br /> of the applicant- Future fila reviews b be confirmed with EHD staff. <br /> g, 'TENTATNE appointment dates rnUst roGessed the next business daY- <br /> 6 ARplicatlons received atter 3:00 pm will be p <br /> TIME, <br /> CONFIRMED APPOINTM04 PATE INITIALS �--- <br /> PHONE FAX <br /> [)ATE CONFIRMED Nr3 REVIEW DATE <br /> REVIEWED YES <br /> .HD 46 06. <br /> m 90099L90E9 9b:bT b00Z/TT/90 <br /> 0/TO 39dd 3I ld� ON S(lldi'11S <br />