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PAGE 01/01 <br /> 10/31/2005 10:50 5102333: ARCADIS <br /> �*.e PAGE ®1 <br /> CWI TAL HEA'L� p <br /> --... .E 01 <br /> 78/31/2005 09:19 4640138 13ANJOAQMCOUM <br /> ErrvutON Z�i,HATH Dr:<RART]VIM <br /> 304 East$lam Ayiiro, ' CA-95202-2709 <br /> Telephone:(209)468-3420 F -(2M4 64 0198 b:wwwsjgov.orglelid <br /> PUBLIC ;CO <br /> ,DS"LE ASEi Al'I`LICAT[ON S <br /> tit7S1NE89fAGBiCY: <br /> ArPr_Icaur; �t�� <br /> ADOftE59; Orb ACS <br /> PHORE(+r�'��� L33- 320o PHOtiE •---_— <br /> X r 1 Taro:2�3 <br /> TENTATIVr'APPOiRIreiWr DATE: , must ba edi <br /> (pias slew 10 pinlness ears koro dere of appscaG M r rtw artilf <br /> 18 gtECY,6oX TO DTEDn"RE4v&9T-fa FEE(CASH OR U+EC7C ola_.T)^FE-CIUM PM�CMM V aBDSIttE;S DAYS <br /> �SIGRA'fURE OF APPUCANT DATE; <br /> imrr L11STRiB0r1OR a va++ o vt+it 2 <br /> U uNt< thittE ❑ UnXG Odter(¢tec6rordehlstsAnapa) <br /> FILE ADDRESS no USE ONLY <br /> st,oees streelnssne <br /> L. <br /> 42 <br /> 4. <br /> 6. <br /> . • ..specific Date Range of triNf nation Requested.prom to <br /> ENVIRONMENTAL HEALTH DEPARTMENT F&ES <br /> p.lNNa52E(UDpj DpION-I.OPi HMMM ABATMO'T 0"-o WAs <br /> Ct3P.xcRDAIRY <br /> �FA�nYh' <br /> TA1m(UST) U Few FACW.T o wAm Tars <br /> .Ld�TAW(l+�Al) T7 Woe KEwt3 p DA <br /> twAuaa�swAsrscsesnATa nn�wweu a gSI As wl <br /> D pUWMTRM*fYAFDP--M9Tar <br /> s <br /> V3 Tam PWAmTaa FACar;T . <br /> O TATroa%k cY Polcs to 'Q PoalSrA t7 Lum llsE AVMscAnorf Smzl <br /> t ZOMALWASTefAcanT 13Q-.MR(PLWIESrM;" <br /> ' YreltMm$m'tc Fsa+9T FeGS ARE AYArt.AB4awnFtAY14W' IrtouowTfl�nA1`&OO AM�.�Pn . Ek�uoeta Hx�oATs._ <br /> s of fifes from the list above by o woldng the <br /> 7. LJst uptoten addresses in the spaee share. Selectthatype( ) <br /> approprWte box(es). Af least one foe Wpe{RUST bo solected Fax o{209)46g 0t38 aT role to the ses,C t <br /> I„a'rcated above__ Address ranges rrdl not be accepted-for addlt9onaf asoistance with file addroeses,cohtact <br /> the Ed{D.Applications recentred after 8:t1D pm eh0 be processed the next business day: <br /> 2 The @HD Yrifl notify the appGca ret If atry EHD Ales exist An appeintmcnt fw review vAll be confirmed <br /> ' appro:timately tan(t0)days atter reeegn of application. The fies will be held for a maz7mum at five business <br /> days for review. Appointmer shouid iae scheduled accordingly. <br /> favlew. Anew <br /> 3. A file that Is actively be1nS wotkEd on b71 EHD staff may sot be Inunedlatofy available for <br /> appCtCation may be submitted when the file b availabto. EHD staff at the expense of the <br /> 4. Any file not retuned in the same condition as reieasod vviil be <br /> e$9a 60 depositptia•to review. <br /> applicant. Future fde Mvievrs by the same applicant may req ' $ <br /> „nom • <br />