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y 4=tiM F1 70 � 5732225 P.02 <br /> SAN f k UIN COU1 ;LEC HEALTH SEFEJICES <br /> ENVIRONMENTAL HEALTH WASION J�7 I Q1 <br /> JUL 0 6 2000 304 EAST ES R AV CA,TMI D FLOOR <br /> STOENVIRONMENT HEALTH PUBLIC RECORDS(209) <br /> APPUCAT10N <br /> t(���.p,�A� <br /> APFuCANT f'-T�B_U9WE351AG2MCY YYt� <br /> ADDRE99 W Q�W` S', o-e- <br /> PH/b(E S-1 { ^ZLZ- 1 FACSIMILE <br /> TENTATIVE'APPOMTMENT DATE 1L C t- 1 ,F, -F <br /> p��r/ fPleew give 7 to 70 o"IrM33 ya AM date of poplWtion aubn,amn� MI r�K NtrV v I_� <br /> �I CHECK COX tO eXPEP(TE RBpUE$7.$7a.00 FEE- EgUEST PR SEED IN 7 SUSINCSS DAYS �(LI C-S �'vl I I �I <br /> A 711 « lc) <br /> SIGNATURE OF APPLICANT 1 ��. /T�-I -- OATE -- �'p (, T^ ' �I-D( <br /> Iz- <br /> TT <br /> FILE ADDRESS Mpi-ICA 14 <br /> IL <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK lust)CLEANUP 51TE(Lop) ❑ ffpUSJNa ABATEMENT O SpuD WA4TE FACILITY <br /> W`01HER CLEANUP 31TE(NON-LAP) O FOOD FACIL" p SOLID WASTE VEHICLE <br /> C1 UNDERGROUND TANK WONITORWOIREL10VA14 O DOO KENNEL ❑ DAIRY <br /> ;W HAZARDOUS WAST!OENERATDR ❑ CHICKEN RANCH O PKG TUATatENT PLANT <br /> M TIERED PMMITTEO FACILITY t1 MaMLIHOTF-L p Pl1a1PlR TitUOKlYagpfCHEM TCILETg <br /> Z) MEDICATATYL <br /> WASODY TE <br /> A POCLISPA t7 LAND U3E APPLICATION SITES <br /> Q MEDICAL wAS'TE FACILITY o PUBLIC WATER SYSTEM C7 OTHER(PLEASE$PECFFY ABOVE) <br /> f. Liat up to tan addresses in the space above. Sslect the ty741(s) of files from the list above by checking <br /> the appropriate box(**). At least one file type MUST be sNected. F2A to f20%4M.0138 or tnalt to the <br /> addte;s Indicated Zbeva <br /> 2. END will notify the applicant If any EHO tilts exist. An appointment for revieW will be confirmed <br /> Approximately five business day$but no later than ten (10)days after receipt of application. The files <br /> wilt be told for a maximum of five business days for review. Ap"fitments should be scheduled <br /> accordingfy. <br /> 3. A file that is actively being worked on by EHD staff may not be)mmedistely available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not ratUmed in the same condition as released Will be reorganl2od by END Staff at the expense <br /> Of the applicant. Future file raviowa by the same apPNtant may require a$78.00 deposit prior to review_ <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 8. Application; received after 3:00 PM will be processed the next business day. <br /> I+I CONFIRMED APPOINTMENT DATE TIME <br /> j DATE CONFIRMED PHONE FAX INITIALS <br /> VIEWED YES NO REVIEW DAFE ! <br /> to a ir"Fbue <br /> TOTAL P.22 <br />