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-SAN J nUiN COUNTYPUBUC HEALTH Sir ICES <br /> _1RQNRAENTAL HE�L.TH DIVI:S <br /> EASJUN 2 9 2000 T STTaciRcTON CA s'szo,2�'FLoaRt' <br /> ENVIRONMENT (209)469-3420CORDS RELEASE APPLICATION <br /> ARPUGANT C-0141, GUSINESSIAGEENCY y`18�i 1n 4,•�Q�fr - <br /> ADDRES.i 1'G�G-Jy� dip t / !'We -S-1- <br /> FACSIMILE l FACSIMti.lrQ{ca Z r <br /> TENTATlve*APPOINTMENT DATE-__.__J'"C s--r�TJ- TIME CJ <br /> (Ploys®give 7 io SO business clays frim[talc Ofapplicatlan submittal} .r a'. 1105 <br /> CHECK$QX TO EXPEDITE REQUEST- FREIEPK SEO IN 3 BUSINESS DAYB IT W, <br /> SIGNATURE 4F APPLICANT DATE .1-&00 <br /> y � S <br /> 3 Z 7-0 Ave2 <br /> :�10= <br /> / __ � 1 z� <br /> r -- <br /> �D <br /> 0 <br /> ENVIRONMENTAL HEALTH E)IVISION FILE, JUN 3 0 <br /> UIiDERGROiI;NR TANK(lIST)CLEANUP SITE(LOP) O USING ABATEMENT SOLID WASTE FACILITY07HER CLEANUP anis MON-Lop) ❑ FOOD FACIL MY I3 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(M4;vNfrORim®m9moVALj ❑ OOG K1=NNLL ® DAIRY <br /> HAZARMUSS WANE GENERATOR ❑ CHWACEN RANCH M PKG TREATMEM'PLANT <br /> TIERED PERMITTEDFAC9jTY 13 MQTWHOTEL <br /> 7A d Pt1fdPERTRUCKiYJRl2DICHEhiTt}ilEl$ <br /> O PTOQfB4DY PE1RCiN6 (3 POOLfSPA ❑ LAND USE APPLICATION SITES <br /> 0 MEBiCAL WASTE FACILITY "RT PUBLIC WATER SYsTW ❑ OTHER FLEASE SPECIFY ABOVE) <br /> i list Lap to tett addresses in the space above. 'elect the types}of flies from the list ab*ve by checking <br /> the appropriates box(es). At least one file type MUST be seleotod. Fax to[2Qlt)44-0938 or mail ba ti <br /> address 6nefi�ateda boV� <br /> 2. EHD will notify the applicant if any EHD fil*S exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application. The files <br /> will be field for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new <br /> application may be submitted when the I'de is available. <br /> 4. Any Ile not returned in the same condition a$released will be reorganized by EHD staff at the expense <br /> of the applicant. Future Tile revl6WS by the same applicant may require a$78.00 deposit prior to review. <br /> �. <br /> *TENTATIVE appouttment dates must be confifmod with EHD staff. <br /> $. Applications received after 3:00 pm will be processed the next business day, <br /> CONFIRMED APPOINTMENT DATE TIME <br /> GATE CONFIRMED PHONE FAX INITIALa <br /> RI�/IEWEj7 YES Nt7 REviEW DATE <br /> enwu a <br /> TOTAL P.O2 <br />