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10/31/2085 10:50 51023332 ARCADIS , PAGE 61/01 <br /> Y 10/31/2005 09:19 4640138 ENVIR❑NME tAL HEALTH PA(3E 01 <br /> SANJOAQWCOUfM <br /> F,NviRoNmmNTA�t HEALTH DEPARTUM <br /> 304 Fast Viebcr'A nU%)� CA 95202.2705 <br /> TdVhoow.(249)468 420 F :(209)46"139 b:wwwsjgov xr�efia <br /> PUBLIC MCQRDS RMEA.SB,APPLICATION <br /> A"OCwHT: aUssrtasstAGENCr: <br /> ACS <br /> 41 <br /> 7iAT r �D <br /> � � a ram. 3 <br /> (Ptaase dleW 10 botnc=eters kom drip of 8*4044M ,�r evie oatr-mmt ba o Wiiem <br /> Q�'cf EC�c 6a�4 roKPEv�rt E R<+QCBT-S 9 F�( Stc UR QtEC�C of�,Y1QUE�Sr P> oE�rsQa It[a(3tl�ttES�V1vs <br /> -' SIGNATURE OF APPLICANT DATE 1,41 � -�... <br /> vea r iaStRtBli1 fOft O Untc 1 C31V 2 , L1nZR 4 Lj%gt a Q t k*c fl odrer{s arrwr�aA[atskna <br /> 1~i't� E$S 1 USE ONLY <br /> santSbV4 Haft <br /> Qt SAG <br /> s, <br /> 141 <br /> 'tQ. 2.1 rt. ht <br /> .specific pate Rage of lnfcosmttiocr Ftrmquested.Pmrn to . <br /> -A <br /> ENMONMENTAL WALTH DEPARl OW FSLES PUS. <br /> TAA(uS1) !0m 0Aq (3 MOVAM AsATMIW D sago WASH Fps rtW <br /> JR <br /> s [ O Poon F1Mtt1 O WAMIWM <br /> DAIRY <br /> I;'�Us ac(1a�+rN-? 0� � Ta'tFr-AtN+rPLW <br /> 13 tt,rxP,rWaaa wrr Qsca o a n t}cnssrdr ta+gra <br /> a Ile=Pt:FAftn mb FAMM a i�vse l4r'ai�+ro4t sn� <br /> 13 TATr oo mam P Pnac1S�R <br /> a Xs=m ,ass VAcLrrr C3craM(RasEs r} <br /> WoLL Atm SEP=pma Remms AM AYMAMS FVR R1EVW- K0WA76VftA-t 4Q AAAA* M s E1�Lt70A W Yt�RYfi, <br /> . fist up to,ten pddt*%&es lA the apa"Above, SeW the ty�e(s of Mae ftom the list Aboae by chec[dng the <br /> apprapmum "et), At l;apt one foe fte MUST be svieoted- �xto txt19�1 AG �4$f7 ar rrtle d tare ses,i a <br /> d;St Bove. Address ranges vAL not be Acogpted—for rtddlt1mW assistance Fly adHs°ecses,aorhtact <br /> the WD,Application*mceiXed alter 3;QQ pm win be pracessd the next lbastness day. <br /> 2. The PHI)Wm hbwy the applicant ff Argy EHD Ates cAcL An appoir tumt far review will be cvntier <br /> ed <br /> 4W*?dmate1y tan('t0)days after toff t of applicatHm. The Mer,VAU be held for a ma)Iamum of five bmsiness <br /> days for favlew. Appoint:trerrts ahotdd ba schetfuted acconTm9iyj <br /> 3. A file fhat Is actively being worked on by EHD , <br /> may not be lmmdlcttoly available for review. A new <br /> application may be aubm7&ed when the Ve is avaitab(e. <br /> i4. Any file not r (timed In the same condition 1s relma cd wW be MMAnixed by EHO stafii at the expe�e vt M4 <br /> applioaaf, future file r*Alewq by the same applicant may requ'ir•e a$93.00 deposit prior to rel r. . <br /> v�saaz-oma <br />