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`Sep-11-03 13:43 From-TTI TETRA T M INC +9188520307 T-507 P.02/03 F-803 <br /> .� U V���� L114 LUas i11�FNNNH• _ <br /> 5 L� Jj SAN aoA UIN COUNTYPUBI-IC HEA�.TH s5R `iCF-S <br /> ENVIRONMENTAL HEALTH DIVISION <br /> SEP 11 2003 f 304 FAST STOEK VEGA!, ®-RD FLOOR <br /> i=NVIRDNMENT HEALTH (209}4s8�424 <br /> RMIT/SERVICES PUBLIC RF=C0RQ5 REI_ SF- APPLICATION <br /> tZth 5lrNE431 <br /> FPPtw1CANT, >3tJS1Nl*SStA NCY <br /> ADDRESS ��� Q 0 10p0 �+'+ o �v''r'c]�ova� Gft- 9SJ►; <br /> PHONE -rf"' `�- FACSIMILE 1�� Q � C <br /> TENTATIVE"APPOWTIVIENT GATE AIME Fr <br /> (Picric viva r wig ousiness vAy3kEirn aato of applicat;on auom;ttap <br /> is <br /> • �� <br /> chECK BOX TO FXPEDITE AEQUE 587.00 FEE-RE ST PROCESSED IN 3 9USINESS PAYSIII AA�) J G1 <br /> SIGNATURE OF APPLICANT DATE 9-a-0o;� � <br /> F Le ADDRESS THIS SIDE RHO STAFF(JSE ONLY <br /> AXEL <br /> PRPGRAM ELEMENTSSCARC11 <br /> 0r7 <br /> i <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> uNDERGROUN0 TAiiK JUS n CLEANUP SITE(LOP) 0 MQUSING ABATEMENT soup wT Y <br /> ,lz �vl <br /> OTHER CLEANUP SITE(NON-LOP) (3 FOOD FACILITY SOUR WASTE VEHICLE <br /> UNDERGROUND TANK(MOf+'rO9ING19IrMOVAL) D DOG KENNEL ® DAIRY <br /> KAZARDous WASTE GENEFRx.AATOR ❑ CIilCKEN RANCH t'PKG TREATMMY PLANT <br /> CJ T1Efmo PERMITTED FACILITY ® MOTELMOTEL ❑ PUMPER TRUCKIYARDJCMEM TOI Xr. <br /> to TATTOOIBODY PEIRCING ❑ POOWZPA - ' D LANta USE APPt.IGATIQN STrES <br /> 4 MEDICAL,WASTE FACILITY 1 ❑ PUBLIC WATER SYSTEM A oThFR(PLEASE SPECIFY A9ove) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list-above by checkil <br /> the appropriate dox(es). At(east one file type MUST be selected. Eax to (2 091 J§J-0131 or mail to th <br /> agc rens indicates)above. n <br /> T <br /> 2. EHA will notify tl a applicant if any EMD files exist. An appointment for review will be confirmed <br /> approximately five qusiness days but no later than ten (10) days after receipt of application.-The file <br /> will be ftl:lcl for alcnaximum of five business days for review. Appointments should to scheduled <br /> accordingly. ' <br /> 3. A file that is actively zein$workea on by EHp staff may not be immediately available for review. A n <br /> application may pe submitted when tile,file is available. <br /> 4. Any file not rcturriao in tho same conclition as releaserct will be'reorganized ay FHp staff at the expert <br /> of the applicanj. FutUCC file reviews by the same applicant may require a$47.00 deposit prior Lo rev) <br /> 5. "TENTATIVE appointment dates must be confirmed with 1=HD staff. <br /> �. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMZQ APPOINTMENT DATE TIME <br /> DATE: CONFIRMED PHONI: FAX INITIALS <br /> v pcviG�nrcn yr .... �•.-•---• <br />