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ENVIRGNMI NTAL HEAL' <br /> SAN Jv..QM Ct U1T1TY PAGE mz <br /> FI�pN1 UNTAL ALT)A D <br /> T RP,AR <br /> i" ?` 2 0$ 304 Bast Weber Avenue, 3"t F3oor, TMLN'r' <br /> Stooktorj,CA 95202.270 <br /> ti Telephone:(209)468-3420 Fax: wvvvcr.sj;�a_ <br /> PLX�ZC ItE+CfJItDSL�ASF <br /> PLICAUON <br /> AP.PUQANr <br /> sc <br /> PHONE{9): PHONE2}: 14 41 Z� � <br /> 7 � <br /> ( 4 - F„ J 17ACBEMILE; 2- <br /> TENTATIVE*Appolr MUNYI)ATE; <br /> 7itno: <br /> (pleQSa allow•iU busip=dey9 frorn date of apPficalloii subfs►Idal-`7'ortati►�onty.demi be C6rttlrmet3) <br /> CkecK OIf TO FXPSDilE REQU S ,$g IME(CASIf OR CHECK ONLY).IgEQUE§r PRoCCStED IH 3 BUSIWSS DAYS <br /> SIGNATURE OF APPLICANT <br /> WE <br /> Electronic Information: Q List U Map beecrpption: <br /> Fll.lw S.S U3�dNL y <br /> 9trset# street etNfdamo 9H <br /> am0 City <br /> Will <br /> Unit 2 <br /> 3. <br /> 4. unit 3 <br /> 5. . <br /> 8. "Unit 4 , <br /> 7. <br /> 1Q. unit or <br /> Speelfit Data Range of Information Re6queststl:pram <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILLS <br /> , woeRmum T.'w(US1)CLemua arra(Loa) CI igyrma AaAT ww=T WA5TT FAQaMNeH= <br /> L'�}4 iM CLFAMUP SM� ON-LOP) ) CFOto 1+,aurr - <br /> L1MpitGt�puNnTigtt}r,��QNIOr{mN�lRi0Yli4) - ©D0olC�1.'N1:L71ta <br /> �Cft aauaw�►srp eArau C3 iC;WMW a itAKCH fA=IRY <br /> ATERU9ATwENTPjAM' <br /> rt R>D PIER�arriEPrAC1tt.rJ'Y G Mordi t 7m Ert 7RUClC1YNmlC�iVl4 Tau rg©FQWSPA usaAPPUCA 0NSnW <br /> JKMLVICAL WASTE FAGILTfY• fl 07+M wLma sae�r} <br /> WELL ANG SUMO PEf4w RrGC9b3ARa AvAILAULS FOR REVD%- MONDAY-FRIDAY%UO AM-SWOPM - Er:CLUAINo NOWAY& { <br /> i List up to ten addreaaes in the space above. Select the type(s)of files from the tis!above by checking'the appropriate � <br /> box(es).'At least one file type MUST be selected. FRx to 120914§44ZJ38 o ail to tho addrtess lgdicateg shoveAdCfress t <br /> ranges will not be.accepted—foraddltlonal asalstOnu W 1110 neldreasas,coritag the EHO.applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2 The EHD will notify the applicant If any EHD files exlsL An app'Dintment for review will be confirmed approximately ton(10) <br /> days after recofpt of applloafioh. Ther files will be held for a dmaximuin of five btrslnase days lar review. Appolniments <br /> should ba scheduled aceortlingly, <br /> 3, A fila that Is actively be(ng worked on by Wib staff may not be Immediately ovallable for review. A now application may be <br /> submitted When thv fife Is available. � <br /> 4, Any file not returned in ft same,condition as relaased will be raarganized by EHb staff at the sx}79aso of the aPplioatlt. <br /> f=uture file reviews by:the same appikant may require 11$95.ou deposit prior to rsview,.. <br /> EHI),USE ONLY <br /> 1 <br /> 113/T9 39Vd SiNvi-inSNOD Iib Sb:ZT 8992/LT/0T <br />