|
E---,a i. Inc SPS0871250 P. 1
<br /> llft� EHO LOG NUMBER
<br /> DATE RECEIVED E D R �A'NJOAQUIN COUNTY
<br /> r7 NVERONMENTA-L,IUALTH.DEPARTMENY
<br /> 304 E).N,eber Ave 3r4 Floe):r Stooktan, CA 95205
<br /> JUL - 8kJ&9468-33,42'9FraT,-. (:,091464-0- 38 Web:
<br /> EMONMENT HEALTH
<br /> PU-B111-C" RECO: DS b'.,f-1'L117,A,.SF, ,kPPL1CA-f JON
<br /> r ve
<br /> '2-2- 11,
<br /> ADDRESS:
<br /> V-Ar-SWL.F.:
<br /> TEN TLAT NE" e,p j;7,:�jWi7FAFWT DATE:
<br /> FEE EZ
<br /> ye Bf-y"N"EX�1.
<br /> i-.'V P'q 3 BMiti—w:`.,DAYS
<br /> SIGNATURE OF APPUCANT
<br /> . ..... DATE
<br /> Dopartmism Use Only
<br /> FWF AMMESS
<br /> unit 2
<br /> 4. 1�ree. I
<br /> 5. 3uaet 36-7 W, i-o"Ise- Avc, C. Unit 3
<br /> �,Yeet 7a
<br /> jr)R 4
<br /> U 5
<br /> -----------
<br /> F-N'V1RONMEN1TX,',-HEALI'Vi K)EP.ARTENT FILES
<br /> Or WVUr-R.`;;RQUND TANK(US1)1--I.F.,"AUP (i-OP) M ASWUHIRF"N'r Cl "C U.0 WASTE F,-}, 1 L I
<br /> .-UDWASTEVi-=Hh-,LH
<br /> 0.4Z�FZMJN-)'TANK UAW
<br /> 91 IMrts 0 virlx:�-,,w'n wv•x*' 01 PA c,TREATww r Fujjrr
<br /> I 1ERED Pl�-RMT i 713 FAr-11.11-Yr 0 13 "a UM PER TRUC K IYARDIC-H-=M TOILETS
<br /> 13 0 0 LAPID USE APOLfCAT;-)N SOMES
<br /> 0 ArEDIC.C.L WASTE FACIL.11Y 0
<br /> 1 V),ten �r.:the-srace aLhema'.. Sek �•'tf:t-e type(s)of Riles f Fam the 1W,above Itty checMtg
<br /> the.-7zp?pT;,Prf; ifs fus". i one )jjpt,� T �W:,viem�-nted. Fax to(209)46 f-0 33 or mai I to the
<br /> 2. riotify the it any El-1B llis arf.-M- Arl appNwitmant uninview will 5-S Oznfirm'-d
<br /> d".,lys but-nQ Latn!than(an(1,01 dar.,aftev rq--cmpt ofappFictation. T',Itp-files
<br /> VeW t4-i rzgd ft�r amef.ximumr W;five btesl :us daye:,.far ruwjew% Appointirmnts should be sch-AW-s-d
<br /> acc*rd i ri 4-,1I Y.
<br /> 3. A-Rif: -s acti-,.sil,,
<br /> Inp vr°orked or, bu s, ff I a1F f-,,ot.be,!mrwxi1;:1teAy 14.w renriew,. A new
<br /> -c.N.a--)'fl 1-11 1:J Abf at',11-Axi lrvhen Vve iv" t Ic-,
<br /> 4. rvl,re (ft the smna cGr;dMain as rittal.,wi usiN bee reorgartized by ala,,,st.11 at the expense
<br /> C4,tC?e zllpiil;ant. Fvtum- reviews by t:;jll-a,.�tl;r�ic,:.il),,,��,cant malY ferquijr Fi,$93.00deposit ri-or pto review.
<br /> .P
<br /> amppointre-ril.,d.-ates mupst be-c%mdhmnttd�vvifth EFOID Stat".
<br /> 6. nm.R it=Ine x-,rracny=,�;,In K
<br />
|