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46401 ' T� • <br /> 11I1g/2003 16:39 � SAN <br /> 'NTAL <br /> YC M ]04t S it Q"5205 <br /> 304 E Webet '�;Web:w,x,�v.co.,.=joaqui causle�d <br /> N 0 v 1 0 2 9}abs-3420 Fax: (2ag)464_0138 <br /> ENVIRONMENT HEALTH ,OLIC C0jWS RELIEASt A)PPLICA'ION I <br /> PERMIT, Q r f <br /> u SUS(NF„SS1AGFNCY: rr��f j1- <br /> APPLICANT, <br /> ADpRE99: FAC.SIM16E. <br /> HONE: 2� `$ 64da , �`O O <br /> Tma: <br /> TENPAT(VE*APAoINTMENT DATE. <br /> 1 l f73 — <br /> (Please allow 19 business days tram data of appliwtiorl submutol) <br /> rHECK SOX TO ExPEDrM REQUEST- CES <br /> S9 E QUEST PROSED IN 3 BUSINESS DAYS <br /> ,rSSIGNATURR OF APPLICANT DATEvzv <br /> DepaMpent ilso Only <br /> FILE ADDRESS UNIT <br /> 1. street 2- O r IV d ow TV' L <br /> Z Street GUSd'" �. YL,(. <br /> t/ �r/F� (,!lilt'i ' <br /> ,- 2. Strom z3 36 &d Ptz -fiV-kcv �y <br /> r R 1 W. f �+ Rd a,, 1�0.G C1 CI(N12 <br /> Iles. sum 6 5 ems{- ahr- �k c <br /> s, st lNs F G 5 F-r>z�- c <br /> r- roet I s5 S Pa_ c <br /> a, sirrrt r�� M�fl 'ra �k�F�a,.� i lfotc 6'H" [ �, nit:4 <br /> s. s� %ftm. <br /> Q Una 5 <br /> to. Sueel a <br /> ENVIRONMENTAL.MEALTM DEPARTMENT FILES <br /> UNDERGROUND TANr,(UST)CLEANUP SITE(LOF) ❑ HOUSING ABA-MMEN r L] SOLID WASTE FACILIYy <br /> OTHER CLEANllp SITE(NON-LOA) ❑ FOOD FAMrrY d SOUR WASTE VEHICLE <br /> UNDERGROUND TANK(MO?M0RLN13MXMCYVAI,) Ci Doe KENNFa. Q IJAIRY �T <br /> r HAZARDOUS WASTE GENERATOR M CHICKEN RANCH d PiiG iCi>rATM&HT PLANT <br /> G TIEMID PERMFrrEDFACILITY ❑ MOTELfHOTEL 0 PKGTREUMPER TM&NTPLANCttEAE TO <br /> 0 MEDICAL <br /> WAS00Y PI FACILITY <br /> ❑ POOLfSPA 4 LAND USE APPLICA-nON SITES <br /> d Mi;i3tCAL WASTE FACILITY ❑ OTH1;R(PLEASE SPECIFY) <br /> f <br /> 7. twist up to ton addresses in the space above. Select the <br /> types)of files from the list above by chockirlg <br /> the appropriate boxes). At least one file type MUST be selected, ax til $ 464-0138 or mae[tp the <br /> addre s ndicated above. <br /> 2, EHD will notify the applicant if any WD files eXist. An appointment for review will be COrlflrmad <br /> appmximatgly five business days but no later than tett(40)days after receipt of application. The files <br /> will be held for a maximum of flue business bays for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked an by EHD staff may not be Immediately available for review, A new <br /> 4 application may be subt'nitW when the file Is available. <br /> 4• Any file not returned in the same condition as released will he reorg2nlzed by EHD.staff at the expense <br /> of the appllaant. Future file reviews by the sante aRplicant may require a$U3.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates roost be confirmed with EHD staff, <br /> fi. Applications received after 3:00 prn will be processad the next business day, <br /> ! CONFIRMED APPOINTMENT DATE Li- TIME C� <br /> DA'T'E CONMRMI=D PHONE FAX tN1T1ALS'• , <br /> R5VIEWED YES NO REVIEW DATE. <br /> efarmo� I JI <br /> Per. iai,tcrer,,cu. I (f; = `rcr,;� �� ��•7 , <br /> t� ��dd it-.�7-�' : �� L'z�c;K=-�z7 ��r��l�'1 -(�1�! ��c.w,i-� ��'��• . <br /> (JS) SlNtfl-lf]SNOS I3tt ZZ19EBZSZ6 bE:L1: E00Z/01/11 <br /> 1 <br />