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}�'j M6401APEX ENVIROTEM INC. ENVIR0t+ENTAL p{-ALIM NO.527 <br /> SAN J OAQM COuny <br /> 5E� 1005 N*.� ONMENTALMALTHDEPnRTMOr <br /> 1 304 Fast Weber Avi"tne, 3`°Floor, Stockto0,CA 95202-2708 EvVIRONMENT HEAWxphone:(209)468.-3420 Fax: (409)464-0138 Web:WWw.sjgoY,org/chd �O 10079 <br /> P�RPAIT/SCFiVICES' <br /> ruBLxc RECORDS I =A.SE APPLICATION <br /> APPt.ICakT: `�x'17 ©/s sustNc.�ssracEThcr: ° -/71/IPG <br /> ADDRESS: '-C / 2// <br /> PHONE(Ir <br /> FACSIhiiLE �g} � '�� 77 <br /> TENTATIVE"APPOINTMEN7 DATA Trma: <br /> 1Pleuo adaw 10 bealness days ItVn dab M apFGca tlaa EtrO�NtW-'i�7 CshK only-mwk ke caM mmd) <br /> kAR <br /> !CK BOX TO EFED GS7,il3.oC CASt(D!t Ci{ECK ONLY)-REQUEST MOCMED V 3 BUSINEaS DAYS <br /> SIG £OF APPI-10A DATE <br /> UmniSTwi6utloN Ntl a Urdtz D nR4 D untts n WAS a OtMT(electronf stslmaF+) <br /> FILE ADDRESS EHD USE ONLY <br /> steete StreetNarrro C1H <br /> C 1 D v G <br /> 4. <br /> fr. <br /> s. <br /> 9, <br /> 10. <br /> Specific Wit Ranga of Information Peg4ested;From to <br /> ENVIRONMENTAL HEALTH DEPAaTMENT FILES j <br /> AuUWZaermu+o rux(UST)rV-" tM(LOP) 0 Harm AeArEM" ❑sow W s,e rn=.rrMK=z- <br /> aTttE':L1-e+i`nrr'srtr.(Nov-.OP) G FOOD FA=Ln r o wASTr TrE <br /> OUNOFRcaoutmTANK(A1Cxa;opuaWReaovua °DOGKENMEL inWMTEwAT:xTRaATMtWPLANT <br /> d KxZkR M WX!rM 0 MIATOR °CT= D M,uPErs Tr�'.A'At<dCHcta 7txte.Ts . <br /> °TrR� P rayFheXm'I ° ❑te1gTusehPrt�tTroTlSM <br /> 17 TATTociBmptp� °P=MPA <br /> D Ror;A;W*TE FAatnY 17 OnrR(F'BAMe SM . <br /> W¢LL Alm swgw PGwnrr RrcaPos Axe hYAXaa�rort neNlw- ptCNOAY FNDA7 0:001UA3.00fw - EXp.wR1C N01-mAls-- <br /> 1, tlst up to ten addresses In the apace above Select tfig(ype(s)of files from the fist above by cheeklns the <br /> appropriate box(es): At least ono file typo yAUST ba selected, fax o(2091 4 64-01 38 or aH to the address <br /> Indicated above._ Address ranges w1A not b?accsptsd-for additional assistance with file addresses,contact <br /> the EHD.ApppCatlons received Af(or 3:00 pm will be processed the naxE business day: <br /> 2 The EHD will nbtNy the applicant ff any EHD(lies axtst An appolntmmnt fol review will 110 confirmed <br /> apprwimately ten(i0)days after recslpt of appfcation Tho files wl(I be held for a T Taximum of fire businoss <br /> days for review, Appoittttttents should be scheduled accordingly. <br /> 3, Afile that Is ac&ely boing worked on by EHD staff may not be Immediately avallabie for ravlaw. A new <br /> application may be submitted when the file is available. D statf at the erpense of the <br /> 4, Any file not returned in the same Condition as relsased Will be reorganl=d by EH <br /> applicant. Future file reviews by the same applicant may requite a$93,00 deposltptior to review. <br /> T)io mcz�a ' <br />