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NOV--22-2004 MON 02:29 n1ng Labs FAX N 59 268 7120 P+ 02 <br /> u ,...,... .....PAGE 92 <br /> -Q4683433 <br /> 4683433 B <br /> 10f19/2664 14 30 <br /> FIFTH� ' � <br /> $AN 40AaUIN.COUNTYiQ <br /> © = i <br /> NTALH8ALVH DEPARTMENT <br /> 304 Ej1,gi'.'Wt�I;R'AVENUE;THIRD FLOOR <br /> NOV- 2 2 2004 sTocK�o:r cA;�saoz <br /> : . ,:. .(209.)-4533%3420 <br /> ENV1R0NN1�.•N-i HEAL ri. PUBUC'RECORM MLEAS•fiE..! #PPLlCATIQ1 N •t' . <br /> { ' E+ 1K �WIY��I` �1DOfGr•IOVI�.S +i'1C: <br /> APPLICA14T 05 U K�ltlL*'�-S BIISlN99JAG� <br /> ADDRESS zZ .Fresno SkaeCt " FfQ snO �i4 <br /> 559-2b'a 3p21 FACSIMILE <br /> PHONE ; I <br /> 2¢m , eC_. iio64 '., TIMB j0--30,.AM` 7, T�NTATIVE"'APPOt3�fTMENTDATE �yteoiappElcstionaubm3ft !) <br /> (Please giro T to 16 business . _ <br /> 3 <br /> OS 1O CMK Box TO EXPEDITE REQUEST >j84Aa FpE-Ri<QU ST PRCG>a3a 5 IN]13t181HE5Si DAYS <br /> �.� DATE . <br /> SIGNATURE OF APPLICANT <br /> TH SIDE EHD STAFF USE ONLY L" <br /> FILE ADDRESS PROORAl41 ELEAEIlTB SEARCH <br /> 1555 W {amn►-el La.,� 1, <br /> r. <br /> 4 3 4 {NamM�tr Larj <br /> La rt <br /> -:? W am rvr r, <br /> N IR6NMENTAL H AL'T14 DIVISION FILES <br /> i UNDERGROUND TANK(UST)CLEANUP WE(LOP).:Q,HNSING i�ATEk1EN3T O SOLID WASM VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILM O SOLID YYASTE VEHICLE <br /> (7C UNDER(WbUIjDTANK(M"jTOF4NGfREkOVAL); -.a .DO.. KENNEL,-._-.':.: O DAIRY <br /> � HAZAW)OUs wASTE GEN111WO11 Cl:WkKEWRAHCH 0 PKG TR3SA`MFNT PtAHT <br /> TIEREA PERA41T1TI3 FaCIt tlY O AAaTEt OYEL: G7 PUMPER TRUC4(J1fARDiCH&M TG3LE"Ts <br /> 1 O'POOlJ5PA::. 0 LAMP USE APPLICATION SAES <br /> E3 TATTOOIBODY PORCING p f3lt ft(?I EASE SPECIFY) C'Gc <br /> E ❑ NIEUICAI.WASTE FACll.JY'M <br /> �. List up to ton addresses in the space 8h6tid. Selnet th types)of flies from the fist above by checking <br /> i the appropriate box(es). At Inst one filo type BALIST be selected: Fax to Z0S 1 $or It g <br /> i address tnditated above. .. ;` .. <br /> 2. EI{D will notify the at�plicant,if any p-ND files exist An'appointment for revtew will be confirmed <br /> approximately fide buslnaxt days.put no:latar*air`fan.(10)days after receipt of application. ,The tiles , <br /> will.be hold for a maximum:af flus iausiness'days for seviOw. Appoint nentg should be scheduled <br /> accordingly: <br /> 3, A file.that is actively being worked on by END 1421E may.rtat be imrsiediately available for review. Anew <br /> ippiication may be submitted v4hal the Pie" I4 BYaltdllle.; ` <br /> j a. Any file net returned In the aame ondi!lon.as,refessed will be reorganized by EHD staff at the expense. <br /> i 'of the applicant. Future file reviews by the sine a001k.01tt may require a$89.00 deposit Prior to review• <br /> S. "TENTATIVE appointment dates must be confirmed with>:FiD'stafE.. <br /> 6. Applications received aftzr 3:00 pm-v�ilI tits processed'the,(text business day. <br /> CONFIRMED APPOINTMENT DATE { bTIIViE <br /> itbNE FAX INITIALS � - <br /> DATE CONFIRMED . <br /> RL;VILe1NE@ YES NO. REVIEW DATE <br />