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gip -.11-03 13:43 —From -TTI TETRA T IS INC +9168520307 � T-507 P.02/03 F-803 <br />�AN JUAQUIN COUNTYPUBi.IC HEAI~TH SEKVICEs <br />hNVIRONMENTAL H1 ALTH DIVISION <br />SEP 1 1 2003 304 QST E06ER A VF-NUg N CA 952 THIRD <br />FLOOR <br />ENVIRONMENT HEALTH (209) 468-a24 <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPt.1CANT n AUSJNESStAGENCY Tr I�{',� El " �l.A <br />-Tn- e <br />ADDRESS /06 s��.- S� l O �'►�n <br />/ 100 <br />► o mord.,, &ff 11 7v ; <br />PJaONE W(0_ & ' FACSIMILE �(�(� � � � � �� <br />TENTATIVF,* APPOWTMENY DATE TIME ftv <br />(PI435c yiv4 7 W 10 Dusina*5 flays kjM datt: Pl appllcaGon auDmittal) <br />, <br />CttE:CK l9DX TO EXPEDITE iREciuE SB7.o0 FEE - RE ST PROCESSED !N 3 9USJNESS QAYS � � ,' C <br />SIGNATUREOFAPPI-ICANT .lam DATF <br />F-NVIRONME:NTAI- HF-ALTH DIVISION F11_Es r <br />ONDERrRDUNO TANK (UST) CLEANUP SITE (LOP) 0 rIPUSING ABATF.MMT b SOLID w 7 <br />OTHER CLEANUP SITE (NON�LOP) ❑ FOOD FACILITY �j SOUP WASTE VEHICLE <br />LINDF.RGROWND TANK (MONITARINGIREMOVAL) O DOG KFNNF& ❑ DAIRY <br />HAZARDOUS WASTE GENEFttpATOR ❑ CHICKEN RANCH O' PKG TREATMI!XT PLANT <br />❑ TIERED PERMITTE=D FACiWTY o MOTEWHOTF-I. Q PUMPER TRUCKFfARQ1CH M TOit.ET: <br />C1 TATTOO15OPY PWRCING Q POOW. PA - • M LAND U= APPI.ICATIQN 51795 <br />4 MEDICAL. WASTE FACILITY ❑ PUBLIC WATER SYSTEM Q OTHER (PLEASE SPECIFY ABOVE) <br />1. list up to ten addresses in the spate above. Select the type(s) of files from the list -above by checkii <br />the appropriate dlox(es). At least one file type MUST be selected. Fax to (209146"13§. or mail to th <br />adgress indicatei7 shove. n <br />T <br />2. EHP will notify tl a applicant if any EMD files exist. An appointment for review will be confirmed <br />approximately five Dw.5iness days but no later than ten (10) days after receipt of application. -The file <br />will De held for almaximum of five business days for review. Appointments should be scheduled <br />accordingly. <br />3. A file that is actively rgoing workea on by EHP staff may not be immediately available for review. A n <br />application may pe submitted when the file is availal?Ie. <br />4. Any file not retufnecl in tho same condition as rclea*eu will tae'reorganized py EHD staff at the expen <br />of the applicant, : Future file reviews by the same applicant may require a $87.00 aeposit prior to revil <br />S. 'TENTATIVE appointment dates must be confirmed with EHO staff. <br />6. Applications recelved after 3:QQ pm will be processed the next business day. <br />• 4 � M <br />CQNFIRM�Q APPOINTMENT pATE <br />- --,. -- TIME <br />DATE: CONFIRMED PHONF- FAX INITIALS <br />I DC\liFM/=n . r . <br />