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r� ra o v 9 cr TSG PAG7 ?4 <br /> E9^. 1.<35 9.6:4� 2594423 <br /> ENO LOG NUMBER <br /> �A OE 'tSAN JOAQUI N COUNTY <br /> 1f U � EN-VUtONMENTAL IUALTS DF PARTIM ENT <br /> SEP 2 2 2a06 304 East,.Weber Avenue, 3'd Floor, Stoaktorl,CA 95202-2708 �/,� <br /> i"r ieebtae; (209)468-3420 Fax:(209)464-0138'Wekr:www'sjgOv.org/c <br /> HIIEAIM pj�L"_a��RFCOPDS RELEASE�kPPLICA ON III"` <br /> ENAAA <br /> NOIIT qq��. ._'�// / Sae fCC �J 0r$+ <br /> a ' <br /> APPIJOA T: iv l��_ ` .....is...°�� �F�- F3USINE66lAC ENC^;, �.� -°-d'"�" <br /> �� �jn Y,i,::=CRs,(•:;i........._..............--�......--.-.....PHQ'aE=(21: FA�I14716E:..w�.r—.__.._ , ,..._. <br /> q�Sr TENTA111E"APP0JMTMEN7 DATE: _ _ 7hne'� <br /> V (Pi®ass ahow to iaustn¢ss(lays from date of application submHml-`TsntaHva only-most da cenfirmad) <br /> 0 MPECK BOX T'D EXPrINTF n-;mr-T-s9P.60 FEE(GASH OR CHECK ONLY)-REQUEST FH60ESSER IN a BUSINES5 DAYS <br /> SIGNATUFkEOF'APPLIOAFIT —DATE , <br /> tc6c�try InkNrtnation i i t i0 map-Description: EHD USE Ly <br /> FILEADOR s <br /> f Stnaet a� e�tN Hama � city � i7;tlt4 <br /> F yct <br /> _.S �4�trv'}` r�.. Ifs. t <br /> —x <br /> : _��� wtt if tt U IVa. ..`(..a_�.�.. .C-br6(►�f,rc—� If �. w.--.- UnMd 1O <br /> VnIkS <br /> 10. <br /> ,pOs i4'n'Late Range of In'rarntation Raquastcd:FR^oiTl .._.....�.�......._. to -------- <br /> fEFIVIRONNtENTAL HEALTH DEPAR•I^MENT FILE$ <br /> tLjDEPGnauuaTANK iUS7)C-LMNIP$nS,(LOP) ©H©USMGADATMNf LA SCUD WAS1EFAGUTV1VVRCLe <br /> CRNsft CLEANUP M(NDN-LOFi ©FOOD FADKRT d�WASTE TIRE <br /> 0 UNCERGROUND TANK(MoNPTOPUNGIR IUVAL) 11 DOG KENNEL tel OwRY <br /> II HAZARDOUS WASTE GENERATOR StGHICKEN RANPH AWAeTEWAIVATREATMENS PR NT <br /> X T(EPP„D S'Er.MrriEO FA0101Y 0 MOTERIHOTEL A�91�PU�svipm TRDcKMAnnIONean TOKM, <br /> C9 TATToomouv P1tt-mo ©POOLISPA IANC'UN APPUCA'nON S4Ta3 <br /> XNaTPOAL WASTE PA^.a.rrr 0 owm(PLFASE sprGir(l,s,_„- <br /> 'tMi-ANI)SEPTOPsIVAT RGCDRD3 ARE AVAUKE FOR REVIEW- M(jNDAT^FP30AY awOe AM-6MOPM - FXCUXNNG HOUDA'M <br /> $. <br /> Lia”up to ten addresses In the space above. Select the typels)of files from the list above by checking the appropriate <br /> bo;t(esl. At least ore fiW type ROUST be selected. Fax taJ20B)964-0788 or mail to the address Indicated above. AddMes <br /> range will not be accepted-far additional asat.etance with file addresses,contact the RAD.App(icattonc received atter <br /> f;GO Pm will be processed the next business day. <br /> p.. The EHV will notfffy the appli:gttt U any EHD files.exist An appointment for review will he confined aopro:dmstely ten(101 <br /> days atter recelpt of apralicefior+. T"iTe files will be held for a maximum of five business days for rovlaw. tppulntments <br /> ,;hoFg;i tt 1,,.4ieduled tneonfinc;ty, <br /> Z- A012 that is actively tieing worked an by EHD staff may not be immediately avaliable fOr review. A rimy AppEcation may be <br /> aubmiRtad when the file 15 available. <br /> 4, Any file not returned In the swine copditlon as misased will be rearganiud by EHO staff at the expanse of the Rppllsant. <br /> suture file revlews by+he Sortie appllesnt may mciulre a$55.00 deposit prior to revlew. <br /> EHD USE ONLY <br /> EiG f&LSHi&(3,t J6 ----•-- - ----J <br />