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04/05/2006 13:27 FAX [6001/001 <br /> -S3 <br /> WrS RECEIVED SA--4 SO QULN COUNTY {1 <br /> EE'YIRO`t`�rflfTAL ::'sLTHEf: RTNi ;iiT <br /> 304 E Wc7cr Ayt: 30' Floor S,%Ocktop., CA 45245 <br /> APQ r 9 469-3420 Fax: (209) 454-0133 Web; wtvti�r.cu.s oaq�i:a.c _t 'W:�a <br /> T <br /> ENVIRONE EW1 HEALTH PUBLIC UCORDS REL,EkSE A.PFL1CA.U0 <br /> - 5�.��L.1WJfN�JJIAGENCY�r�, � ( - `�—�--•--- ..__.. <br /> AP PLJC 4X7:�� --- <br /> ADDRESS' L: ..— <br /> { <br /> _:SITE .- FACSIMILE: �1,��L-i- --�"�-- ----�_' �-- <br /> TENTATNE•APPOINTMENT DATE; Tomo; ..... <br /> (Please allow Ia buxiness clays from die n4 xp¢lira;lon su6mtt 23) <br /> CHECK BOX10 E"E L)qE REEQU>~ T-$93.00 l*E,— EQUEST PROCFSSEQ IN a BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT pcparunentsase 4ntr <br /> UNIT <br /> FILE A,00RESS <br /> rut 1 <br /> 1 yr eel <br /> �rrar � <br /> .3. <br /> -7 f- G <br /> Unit.3 <br /> Unit 4 <br /> 7. <br /> Unit 5 <br /> ,o. s S Z"7 G E, M k/ saUt 4� Gt+ <br /> Q � .w <br /> pEPARTMENT <br /> ENVIRONMEN3AL N TN FIlnES <br /> _J <br /> O HouSING AIIATr_-MF_ T �-d_ -Hr',=TE=FACILITY <br /> umDERGROUND TANK(LIST)CLEANUP Sfl�(LOP) 12 FOOD FAC3LCTY E7 SOLIC WASTE VEHICLE <br /> OTHER GLf�ANUP 5r1 E (Nrl; <br /> opP) O DCOG K NNEL VA1R r <br /> .M UNQE.RGROUNO TANK(MOt4r 0R1NG1REkIfJVAS-) 0 CHICKrN RANCID S-PKG TREA't�Pr ENT PLANT <br /> 54 <br /> X KA_?1, DOUS WASTE GENEERA.TOR ❑ MOTEIJl�Q71 L 0 FLEfrtpFIR TRtJCyryA� =nlGHE1V TotL_e S <br /> • TIERED PERMrITY l-TED FACIL [DMOTE_1 A L LArio use A.PPLICATiOr+51Tw5 <br /> • TAVOO/LMOeY Fat-RCINa ME01C_AL wASTG FACIIS Y [! QT?!ER(YLEA,E SPS Cif-f) - <br /> G3 <br /> �- Mixt up to ten adGresse:i } the space above. Select the typc(s) of files from the 1'15t ah-.aye by checking <br /> box e� At lea.t one fila t ' e MUST tae :e4ected. Fax tts Uta 4l>4-71 3& °_ r_ n—''�E 1p Wit' <br /> the appropriate ( )• !� <br /> address indiCatCd 2bOye.PI' c ointment for review w"stl be Confirmed <br /> 2. EHD wilt nOti thea licant if any EliI3 file ., exist. An app t of pp, <br /> approxiltlotely fi+rc business days but no later than tr_n (1(]) day-. p <br /> ointrnentsshould be SChedu ed� L. <br /> will be heIrl for a maximurn of five businCss days fqr review_ AT1p <br /> accordingly, <br /> 3. A file that is actively being worked on by EltO staff may not be immediately availahle for review. A neVe <br /> ap¢EiGatiort may be submitted when the file is avaitsbie_ <br /> 4. Any file not returned in [tae ame candition as released will be rlrorganized by 1ni�D staff atthr, expene <br /> of tt,s applicant. FuturejjC review:; <br /> e i w:b be confirmed Yrith t rnastaequire a $93.40 deposit prior to review. <br /> of <br /> ~fEN-i ATNF appointment <br /> fi. Applications received after 3:()o pm will be processed the next business day. <br /> . - <br /> ------------- <br /> Time <br /> rDAT� <br /> NFFRM E .'APF?OINTMENT:DATE-' r <br /> 'Pi~kOEaE FAX <br /> iRiTl,?t,S IEWeD YES 1'10 �_ F.EVIEw DAT! <br />