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NOV-16-2010 TUE 08;59 AM Moore Twining Associates FAX NO, 559 268 7126 P. 02/02 <br /> aen rc8nc5c vcu5 10:46. 4640138 _ EWIPOF-0WE:NTAL HEALI, PAGE: 81 <br /> i NVIIlONMi~N7'.AL HEALTH.DEF)V= <br /> 304 East Weber Avvnv,,, Yd Flooi,Staokton,(A 95202-27 71500*Telephone:(209)468-3420 Fax.(209)454-CI18 Will:VMW.sjgov,orVehd �(t <br /> PUBLIC R1P;C�Id}►,S llZELE; 61rAE"PLICAr)<ION _ <br /> �''�APPi,ICANT: . Pk, (t; Mc.ryi✓C'Z .". ._. <br /> -. 8U51NES31443ENCY <br /> ApDREssv 2 5.77-2 '7' l—v e s r c, S+1 ee� y <br /> Fie s . v C a 3 7Z <br /> -----------�-r-- �-- SSV - —FACSIR9l.E <br /> TENTATME'APPOINTbtENTDATE•_ ! i2 (a Tim. 00 A � ' <br /> (P,.,,slluw'f0 b�uto:eaa days barn date of:tI)PHOW0n Elllpt"MAI--°'YnTfafNe only-;=�nFmNWI <br /> 13- CHECK BOX TO&PFDRE REr 11W-T.$93.06 REE(CAIN Ok CHECK C+MLY)••REQUC-ST CESSLV-Ifl 3 9USIMESS b4YE <br /> IGNA7UItE OF-APPLICANT. —_ PATE <br /> ' tiwT b(3T1t1131T11ON : G Unn t ��2 'i],Unit fY O MtU 1 C1 Unit 0 17UnH <br /> c�etran�r111eWrnAp�ay <br /> Stasats_ ' Strcetattme ': n Ekb USE ONLY <br /> 3010 L,t,/.. :: rP 6 �Tsoa.d <br /> TfllcX <br /> 8. <br /> 9 <br /> Sp:eolfic 1)a4:Range of ff)anktiott lyeque9ted: rorti <br /> ENVIRON MENTAL"EFW i DekRTMEN'r PILES <br /> ( •.4LFceiob ADTUIXfUST?PIA' {LOP) �HOustugy AaAn.n19}r , to 0,=WAstE.FAaLr YN9"uAe <br /> OqH&CtIsoNYP sr'rs wtf-W.P) ❑rooz,04cwry r]wAsie ilAe <br /> TdumQomoutwTMk(Mt}t:rroalWREMCNAt 'o 6rW <br /> Dbw+cmgeL GppAmY <br /> Q(,�t�tt��,fft(oOVe WAareOsKCPAToa�' :: r.:O�P Ktut n vtcw A.sieWAiFIt;TREAtrf,EKr p1,Atlt.. 11 <br /> t3•'fynhopErw!rt1QeFLCtiirYO( :DM�YE;i(lpriet - C]„ppONruETRUcItA'MdCtieMTgt><.i9 <br /> h'TAiteoreoOYPteacwo - .❑PontlSrA ' - ' iG,LAtm USE AnFudnnoK src>:,s. <br /> 'G JAeo1CAL WAi4EPA0LIrY rJ P}IIfi71(hGsl'SPEellty),,,,e --r-.. <br /> :.WEut�DBPVne t?eR►ai ttttC0.e119 AREAYARAEU F00.IfRYleNf• YVlortpAY-PRroA1 Yt'OOAM-6:OOP4( �ca,Ldlro HOUOAI'a <br /> ✓7. List up'to top addr¢t}sta fn tl(e space a¢ove. 3aieet <br /> that <br /> ype(:;)of filas'fr'wn the list abpv;e by checklug the <br /> app'roprlate box(es).,At lust pf)e file type.MtJST'be stlr gifted. <br /> Ie �� a�0ddoMall <br /> nd7catedAdraes l? gas will not be arospW -tpr•arldhi” 1 asslstac�With e a s <br /> 1llte addeassms,rontaet <br /> the EHR."A,ppheatioi s"recaivad ol{tae,3:Q0'pm will be prect)sseid tho flirt business <br /> 2. the EHq Nrlll notNy t e,�pp1tGpht M ahs}EHD files ezlst. ALI ap:polaitntePtt Cor review will he oonfitr104 <br /> ap4Traxlrtta lytep(a0)dais)lltoFecp!j(ttofcppl4cW9n. 11befliwi v111tehotdforamaxtmumot8irsbusinesa <br /> days fol review.:pjtpgfMXptpfs shoulidbe srhDd0jed ac courlmgf t <br /> 3: A rile thatl9 actively bolpg wu'rkad qp by Elio afaft may nit hey immediately avallahlefiar review, A It4iV . <br /> applieatioh'ptay 6e sobiaitted vehen tho,fnle Is availgble. <br /> Is not returned Tn fh6 sadr a oanditkin as released w6 ba moiga0zed by EH®;;tiff at the expeitGe of tate <br /> applicant EuturefIle revltiws,lrjrthegafretapplieatntrroelyfagtsirea.W9J.®Otieposit.priortontviaw. . <br /> A, Alaaa— <br /> ] v , <br /> Elm abaaax' - <br />