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11/22/2005 14:22g� 916-7 F q " LFR PAGE 01/01 <br /> 46 ' <br /> M/IR <br /> ONmENTAW1 ----PAGE 02 <br /> SAN JOAOU IN COUNTY <br /> 1 1 22 2005 ENMONKLMAL HEALTH DEPARTMENT <br /> 304 East Wobeer Avenue,3`d Floor,Stoddtoa,CA 95202-2708 <br /> ENVIRON;MEN1 HEALTTelepbone.(209)468.3420 Fax:(209)464-0138 Web:www.sjg0v.ore6hd <br /> Z0q q7 <br /> PEP,(�91TiSERVICES <br /> �w PUBLIC WORDS ULEASL APPLICATION <br /> APPLr—W: E-aWx Za YL SUSVESSIA(3MCY' L�'� �U 1✓R 1�tC_Q� <br /> ADDRESS: 7 $lam '2-4'-.,O _ <br /> ptiow(1} .91(D 9t, 0 Za MOME(2): FAc [+10.E: I '71_0 03 toy, <br /> ----_. <br /> TENTATIW Ir,Pp iu I im T DATE <br /> (Pkasa a14w 10 txtslness days from date submitW.•T,no"only-must be oodfimwed) <br /> CHECK BOX TO EXPEDrTE REQUEST-$53.00 FEE(=HOF(CHECK ONLY)-REQ=T PROCESSM'N 3 SUStHESs DAYS <br /> �iGNATURE OF APPLICANT DATE <br /> t*w DCSTRf urm O Unit 1 d Untt 2 ❑Unit 3 O lhift 4 O Unif s ❑ Ltrit 6 ❑ O&w(d-*vWd9zEsh } <br /> FILE ADDRESS MD USE ONLY <br /> Stn sf fK <br /> suvet Raw QV <br /> '1. <br /> 3. <br /> d. \ <br /> 6. <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> `Specific Data Range of Information Requested:From to — - <br /> t31MRONMENTAL HEALTH DEPARTMENT FILES <br /> c taaro TAtac Amur SrsE(tAP} 1 Ha=mo AMATtNNT M som WAsTE FAMMIV <br /> EMLE <br /> i1 Food FACXM [7 WAM TM <br /> ❑OTN1:�R CLEArnM St7t:(NONa-QF') fl DA&�1f <br /> dkkmmoRMl DTAW(�AotrtOMVRMMAQ ❑Dw K <br /> 'I.i{AZARDOVS WAM C;c Q RAt�t( JtktilYas7�wATi TSI raFtts PIAT <br /> E3 TOTD S'6onlIED FA== ❑�ra. . O PU&WF-g7rcUCtCIYA <br /> D T�TrootBoDY MOM 'E3POOLWA D Lim LM A��'N SrM <br /> II MMM WASTE FAar rrY ❑Oltst(PLEASE 10 HOLIDAV� <br /> Wk'�.1-ltiJ S�Y4�P AR£AYAAJIBLS FnR�Yft'N(- �ORiQIIY-FAY��Q M���� <br /> 1. List up to ten addresses In the space above. $eieat ti�•t,)e(s)of files from the list above by checking the <br /> appropriate box(es)- At least otic file type MUST be selected. fax to_(209I X464-0138 it mail to the address <br /> indicated above. Address ranges will net be accepted--fol additional assistance with file addresses,contact <br /> the Fltl].Applications received affer 3--00 pm will be processed the next business day.' <br /> appointment for review will be conf rw�cd <br /> 2 The EHO will notify the applicant if any EHD files exist. Thles will be held for a maxSmrmn of five business <br /> approximatety ten(10)days after receipt of application, <br /> dayFs for review. Appointments should be scheduled accordingly. <br /> 3. A fde tett is acfiveiy being worked pri by EHD staff may not be immediately avOable for review. A new <br /> application may be submitted when the file is avaltabte. zed by EHD staff Mt the expense of the <br /> 4. Any f1le not retumed In the same condition as ient �l b deposifi prior to revievr. . <br /> applicant, Future file review by the 6=1--app y require a X93 <br /> �K <br /> p{p 4842-40'- <br /> w2=4 <br /> 842-006w2=4 <br />