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IF <br />FEB -25-03 12:54 PM <br />82/251fn�y <br />. SA <br />FEB 2 5 2003 <br />FNVIROM1,16 r HFALi <br />PFR,^„rT/SER VICEPL <br />CAPPLICANT � FL e, n <br />1 l ADDRESS///��^�^-�''iZ+��/ <br />PHONE <br />C7)I0)q13-339 TENTATIVE' APPOn <br />0/l CHECxGD%TOEXFEDITEAI <br />*SIGNATURE OF APPLICANT <br />1 <br />Etv3NUum.rA_ HEALD <br />-' QAQUIN COLINTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />704 EAST WEBER AVENUE, THIRD FLOOR <br />STOCICrON CA 95202 <br />(209) 463-3420 <br />31 -IC RECORDS RELEASE APPLICATION <br />P.131 <br />DATE TIME.� <br />give T to 10 bualnoss days from date of appl!eaflon sulNnKW) _ 0 <br />FEE- REQUEST PROCESSED IN I DUSIVE$S DAYS <br />I � _ DATE <br />-03 L�--S) <br />31 <br />FILE ADE <br />RD3G T93 SIDE END STAFF USI! ONLY <br />psou RAM MAMENTI: SEARCH <br />O SOLID WASTE FACILITY <br />approximately rive bl <br />O SOLID WASTE VEHICLE <br />vrM be held for a may <br />0 DAIRY <br />O PKK T14EATAtENT PLANT <br />accordingly. <br />e-,OreL <br />91 �-�Sw_ <br />0 LANC U$E APPLTATION S ES <br />O OTHER (PLEASE SPECIFY (DOVE) <br />application may boa <br />4. <br />_ ti 5 r-) w St�t2f <br />5T <br />no <br />5. <br />'TENTATIVE appoint <br />0. <br />Appliealion:iroceive <br />UNOERGROu1:DTAKy-to )CLEA'. <br />OrNER CLEANUP SIT (NON -LOP) <br />UNDERGROUND TANK (MONITORY <br />HAZAROCVS WASTE GENERATOR <br />(TIERED PERMITTED rACILITY <br />V TATTOO/SJDY PWRCING <br />0 MEOIGAL WASTE FACILITY <br />1. List up to ten adorors <br />the appropriate box(c <br />address Irdiclated ab <br />2 <br />EHD will notify the at <br />O SOLID WASTE FACILITY <br />approximately rive bl <br />O SOLID WASTE VEHICLE <br />vrM be held for a may <br />0 DAIRY <br />O PKK T14EATAtENT PLANT <br />accordingly. <br />3. <br />A Me that is actively <br />0 LANC U$E APPLTATION S ES <br />O OTHER (PLEASE SPECIFY (DOVE) <br />application may boa <br />4. <br />Any fila not returned <br />Fax to 21 09i 46a 01 or all lG Ih <br />of the applicant. Fut <br />5. <br />'TENTATIVE appoint <br />0. <br />Appliealion:iroceive <br />ENVIRONMENTAL HEALTH DiV(SION FILES <br />JP SAE (LOP) O SOUSING ADATEMENT <br />O SOLID WASTE FACILITY <br />O FOOD FACILITY <br />O SOLID WASTE VEHICLE <br />:)REMOVAL) O 000 KENNFL <br />O CHICKEN RANCH <br />0 DAIRY <br />O PKK T14EATAtENT PLANT <br />❑ MOTEUNOTEL <br />O PumpER TRUCHNARDP.H1MYO1LETS <br />O PCOLISPA <br />0 LANC U$E APPLTATION S ES <br />O OTHER (PLEASE SPECIFY (DOVE) <br />a In the spaeo above. Soled (no (ype(s) Of <br />IIID$ Iron, the 11M above hock(na <br />1. At least one filo type MUST be selected. <br />Fax to 21 09i 46a 01 or all lG Ih <br />re. . <br />iicant V any EHD files exist. An appointment for review will be confiiiined <br />inass days but no later than ten (10) days after raealpl al applicalionl The files <br />num of five business days for review. Appointments should be seheIduled <br />ping worked on by EHD stiff may not be imRlcdlately available for re, <br />bmilled when the file is available. <br />T the same condition as released will be roorganl0d by EHD stall at i <br />re filo ravlowe by the Sarno appl;cant may requVe a $119 OC deposit prl <br />font dates must be confinnod with EHD staff. <br />after 7:00 pm will be proccssod the next business day. <br />CONFIRMED APPOINTMENt DATE <br />UATE CONFIRMED <br />tEVIEWED YES <br />TIME _. <br />PHONE rAX INITIALS <br />NO REVIEW DATE <br />N. A now <br />expense <br />la review. <br />