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I <br /> OCT-14-2004 16:09 From: 18884976250 T� �40138 P.1/1 <br /> CX[D LAS N�IP+1Q� . <br /> E1 <br /> }au,Tc-REMFVF-p- SAN JrUA QVW COUNTY <br /> p <br /> HEALTH <br /> g 3 FlOordQ4 CA 95Z�S ErAATMNT <br /> Q NTAL HE . <br /> 304 RVIB Stchd Z01 <br /> 0 C T /1 2 468-3420 p'sx: (209)464-0138'Web.www.co.aaa}oaq .caui�l <br /> ` LIC RFICOS R� •EAS AY.TCA' ' ONMOM <br /> yY.O� <br /> APPLJOART: �v1/D a S~ Sir <br /> ADDRESS: <br /> M�scron� Go e gg r�$7-6a•S'� <br /> pNOra!!: fX <br /> 10 p TGns: <br /> TP.NTATTW Ai°PoiffMI NT DATES gw�ti4n svbmldaf) <br /> tP140a Mi1OW IQ OWOMM+ds+from d++� �►PP <br /> CHtYCK RWc TG pCPiRlI P RRQUEST•$63.00 for- pIrou"T r 3q.D IN!puelNM nAYs <br /> DATE <br /> GIONATURE OF APPLICANT p. nt acv <br /> WN <br /> rl <br /> Unit 1Ile <br /> � <br /> -. -... 4 <br /> Unit 22. <br /> Unit a <br /> E' <br /> u`'n%4 A <br /> 7 Unit 6 <br /> ' 1 <br /> ENVIRC►NNIENTAI-HEALTH pr-pARTMENT FILES <br /> FACI <br /> (fNpllPtGROUMIaYANK(U51)CIAMUP WX(tap) 0 HO SM0 ADATEMMT c) dQMV YY11WM YFM L <br /> QSlaiaaq .EMi1JP ai1TR In FUN01"11 oYALI O WG KENN84 M PKG C3 V000 VAMO-M cl T t T M%T PWWT <br /> UNDERGROUND TANK NOW0 p WOKEN RANCH cl PUMPRR MC10YAWHEM TQiLM <br /> Gt HAZA�a WAM GuN9RATOR MOT�LRtG7EL ,p p APp TION altTlla <br /> cl <br /> TI!<1tlD PERM IACN� 13 P001APA H S <br /> c3 TAT-rowpdaY PIERCING p R tPa.'k�48C OPIQCIPaf1 <br /> 0 MAGICAL WAM PApLRY a;healdng <br /> 4• t.1it Up to tan addraseos In the NPO' above- 5*10ct that types)of flies from the list eb�YQ pY 1 <br /> tho appropdAtQ bvtc(es), <br /> At least v fila fm MUST be nelectad. 202 <br /> da n <br /> . Ftp will notify the eppli"M dany t no liter titan ten I4 )dsysed <br /> 4si'tar M#1 OPPIlo lati.The files <br /> approxlrs~artaly flea plaainew ye lntments should be$Chpdt�lad <br /> will be hold for a Matxlmuan of f1Ve slFWas det145for rwlew. Apps <br /> accordinglyEMD staff maty not be Irnmedlataly available for rsvl9w. A nM <br /> 3. A file that io ac&@Iy being�xarlcsd n all <br /> application may he submitted when the file 15 availabta. <br /> 4. Any Elle not returned In the same t b the same&&pion as liant mgy"Ira s$93.00 deposit prior t rawlnw. <br /> of the applicant. Future fll4 re Uat be Connrrnald with VH0 staff <br /> �. 'Tpd7`ATIVIE eppaintment tithes m � <br /> 6. Appliastlane rgAntYRd soar 3:00 pmlwip lac pr+�ceaeed ttto next bualr�ass+day. <br /> TIME•.i..l.:'J- <br /> DA'T'E <br /> RHON11 � FLAX' <br /> jIIEWEt3YESNG <br /> REVIEW DACE <br /> � •�""", H.L'It�1-1 �Y.LN�IIJLITIW� 6E'C0fr9b 5L�9'L ti6PJir/tif/B'L <br /> L0Jgd <br /> EI <br /> I <br /> ,i f <br />