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�or ray.gg�t,T.T�DpAR izvr �r <br /> o itockton, 2 <br /> 304 East W gibes Avenue,3'�2P'10 t� CA 9 > e�OOig/Zhd <br /> 1 Fi ?N5 Telephone: a09)468.3420 Fa:o( ) 138 Web.WWW4e [��/ <br /> 3 <br /> U,1,&;0NWNT HEALTH pUBLYC nCORDS ItEI.E•° sE AIPPLICAr"ON <br /> Co K <br /> PGnpp ISFReUSINOS1AGINCY: /SG <br /> CA <br /> WA6 , <br /> APPUT ANT: t"DI Np Slrre G �Q— nti WWA6 til/I <br /> ADORESS: PHONS(2): Tim•: <br /> PHONC 111: <br /> TENTATIVE"APPOINTTEP-NT DAT�trom date or sppStat On eubnflnal••Tan6Nv onlT^must b•ooNlfum•4) <br /> (PNas•allow 10 buslnasc days' CASH OR CFIEelC ONLY)�REOUEST PRO=E 5ZD IN 3 eUSINM DAYS <br /> ❑ CHECK BOY TO ptPeon PE ECT•107,119 ME( DATE 2-var <br /> SIGNATURE OF APPLICANT ❑units ❑ Units D Other Ul•CtMMICJ1 WMPs) <br /> UNITDISTRBVnQN dUnit1 DUM2 unit Una4 <br /> FILE ADDRESS ah EHD USE ONLY <br /> Str••tY sCe•tsam• <br /> 1 to dQ ^ <br /> 3. <br /> 4. <br /> 5. <br /> 7. <br /> 9. <br /> 10, to <br /> $p•ciflC Dau Mange or InrOnnat)on R•Quabd:Pram <br /> pNY1RONMENTAL HEAD DEPARTMENT FILES ; <br /> C SOLO <br /> In HCutiN6ARATWCI w1W AF M F•au1 Nmcul <br /> ' <br /> 1 UNDIRGRDUND TANK Nm CLHANUF gine iLDP) p FODO FAWN DAIRY ]PI <br /> T <br /> 11,OMR CI-ZOUP$IT'(NON-LOP) C3 Do oW"MNATERTKRATavnPLA" <br /> yLUN ZNWuNPTMK(Maru 18ClRdevW ❑CKGtORANcn C PUUPMTRUCKNAAWCxWTOILKnI <br /> Q fjAZAaoous WASTe GE.NEMYOR C MOT{UHa= C LAND Use APPLICATION SRES <br /> D TIRY7a PeIWTTTED FACIWTY ❑POWSPA <br /> C TATTocMDYP1exC0NO C Gni oral AEESF=I <br /> O MgCMWAM FACILITY "DAY-AUDI.Y5:00 A)A4:OOPY - ixCLUOIKc HOLCAY1 <br /> WE"AND SV=PEI1111T FUNcO•DEARa AVA TA➢LR rOR RCYIer+ <br /> 1. List up to ten addrass<+e!n the:pats above. Select the types)of n at from a�st show by checking the <br /> mail e a <br /> appropriate box(es). At least one fNS type 6AUmc be selected cs with fila addtesan,wnt'cl <br /> Address rsngss will not be accepted—for additional t bU sten <br /> the EHp Mplcations faaelvsd after 3:00 pm will be processed the nazt businaaa day. <br /> 2. The END will notify the applicant if any 1"3 flies exist An appointment ford for aview will m confirmed <br /> �proxltnately tan (10)days after racolPt of aPplication. The fllee will be held far R ms7dntum of flue business <br /> days for review. Appointments should be s t esdUtytt accordingly. <br /> Y of beg mmadistely available for review. A new <br /> 3. A filo that Is sctivaly boine worked on by{:H D staff at the expense of the <br /> application may be submitted when the file Is xvai(abls. anized by <br /> l be red <br /> ow <br /> a Any filo not returned in the lanacondition sxme a s Ilcant mayOrovire a$93.00 deposit prior to renew. <br /> applicant. Future file rev(awe by PP , <br /> r, <br /> ` <br /> s 'e. --�— <br /> +u�vss <br /> 1:0 E@Vd <br /> H1'Ry�i "1tl1hG�V(I'i�IN�l3 8ES649b 9Z;8T 590E/BT/ZF <br />