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EWXRONNENTAL EEA• PACE 01 <br /> 06/23/2004 15:25 46401. ' "• '" " <br /> DATE RECEIVED SAN JOAQU)<N COUNTY <br /> INEc� i�WEo ��w��Floor �nPCA995f�S5`1T g7�3 <br /> J UN 2 3 San 468-3+120 Fax: (209)464-0138 web:www.co.san joagirin.ea.us/eI'd I <br /> ENVIRONMENT HEALTH PUBLIC "CORDS RELEASE A PPL ICAITON <br /> 5U=C=ACEXV1 nth <br /> .APPUCANT: n cernuc �ed1'2 <br /> ADl M.W: Z l� F -2(J.5/0'-55oy <br /> !09 ,FAcsne9t <br /> y <br /> PNCNE: rm1e: <br /> T£NTATW AppotNTMENT DATE; <br /> n (please aliax 70 Desinesa dsas ftom date of appllcedon submittall <br /> 1-� CHECK60XTO'ElQ'EOrtE RE-0UEST•79a•�FEE'REQUEST PROCESSED IN s SUSiNESS DAYS <br /> DATE ---- <br /> SiGNATURE OF APPLICANT Depxr ,*At Use O:Uv <br /> UNIT <br /> nDDREss1 ❑ Unit 1 11ii <br /> N W441 5� Kw d/lPA"' <br /> ,. � a3s�7 d 1 <br /> Unit 2 <br /> 4 <br /> a eves, <br /> �Uoty <br /> 4 <br /> [] Und 5 <br /> 6 Yc <br /> 0. Sees <br /> 10. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOU3d1G AaA'rtMe X sOUD WASTE FAGILr1Y <br /> �(UNDERGROUND TANK NST)CLE.WUP SrTE(LOPI M FOOM FAC>LIT'r JFC❑ DAIRY was'rE YEH�IE <br /> Ja OTHER CLEW UP SITE(NON-LOPI q DOD KPM+EL M DNRY <br /> rL UNMERGROUNDVAKKCMONn'OrLNC>FICMOVA) 0 CHICKEN RANCH M pUMpgRI�Tt�tCK[Y IPNT <br /> / }IAZAROOUSWASTEGENL'RATOR ❑ MOTEUKOTEL ❑ LANOUSpAppuYAMNSIMTOILETs <br /> ❑ t,pNp U$E APPLICATION SITES <br /> TIERED PERMITTED FAOILTrY p pooLSPA <br /> 17 TATTOOIDODYPIERCING P OPIFKIVL A3CSPEG1F11 checidng <br /> El MEDICAL WASTE FACILITY e s Of files from the list abOY6 b9 <br /> In the s pace above. Select the typ ( ) tp 209 464-01 r mall to the <br /> q. List up to ten addresses MUST be selected_ Fax <br /> the appropriate poX(es). Al least one Ota type <br /> address ind ted Mbave. IntmOntfor review, Ua�,an�The files <br /> the applicant If an bEtlt�e la�tee than ten(10 days after receipt of appilca <br /> Z, EHD will 11 gly ointments shoUld be sGiledUled <br /> approximately Five business days for review. App <br /> will be held for a maximum Cf Five business days not be Immedletoly avallabis for review. A new <br /> worke <br /> accordingly, d on by EHD staff may <br /> g• A file that is actively being <br /> e Sarno aandilion as released will be reCrganized by CHO staff at the"Pense <br /> application maybe a in the d when the file Is available. require a$93.00 depoolt prior to reJlew. <br /> 4. Any file not retumed in th tII®soma apptitxnt may <br /> 4 <br /> of the applicant. Future file reviews by rmed with EHD stall- <br /> s. *TENTATIVE appointment dates must be a pr <br /> wHl be proeaeeod the next bUslness day- <br /> s. <br /> received atter 3:00 pm 1... •, 1.:J,:;.i;;. <br /> TRA E <br /> CiDNPIRNiED APPbit�7M> T VATS,... <br /> PHONE <br /> p 7 Et,ONFIRf(f�D,; P"EW DATE <br /> REVlE1NED +•' •'YDS NO <br /> ola . <br /> eMawa <br /> L0 30Vd dw35 OZ19SEE-606 81:171 t+00Z/EZ/90 <br />