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I 1 <br /> 05/ 11 / 2004 14 : 50 4649138 ENVIRONMENTAL HEALTH PAGE <br /> 01 <br /> -ERf\t f hriu I UU ry <br /> \lR _ � � SANJOA,QMCOUNTV <br /> E1IM0NIYA NT,AL gEA.LTH DEPARTMEINT <br /> MAR w 9 Z006 304 E Weber Ave 3' P10017 %00k=4 CA 95205 <br /> 209) 458-34201;"ax: (209) 464-0138 Web: wwtv,c0.slm jpaquin,ca.us/ehd a <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS MEASE APMCATiON <br /> r A1+PLYCgNT: yT�t r sUSINFSWAGL'NCYI sus <br /> >AouRe5s: 33�U ror �t'�,.eat{i S I�C SSo C.a�nrz.,; Pak' , <br /> auNle4;1; ) <br /> TEiNTAriVi=" APPOINTMENT OAra: WttkaW drrl 10 [oil[ (ocIw% <br /> „ YTinti: <br /> (PHiase allow 10 bw in= days from data at appligr4on submitW) <br /> CHECK IROx TO ExPE ATE REQUEIIIT - $93.00 PEE m REQUEST PROCESSED IN 3 BUSINESS AAVs <br /> 35IGNATUIi6 OF APPLI ...AN7 DATE 06 _ <br /> _ Depeftent Uso Only <br /> r� _ �.� � FILJE ADDRESS OMIT <br /> QI Q Unit 1 <br /> '-I Uni( 2 • <br /> p• ffUGG! _ _ p �y// <br /> fi !treat C / <br /> r, sueaiMyl(J� <br /> „• <br /> ° D Unit b <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> OOK UNDERGROUND TANK 0 rST) CLEAN!; P SITE (LOP) M ROUSING ARATEMENT ❑ SOLID WASTE FACILITY <br /> d OTHER CLEANUP Srtg 0ION-LOP) 13 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> �; UNDLRGIROUND TANK PI(INITORING 'R6MOVAL) Q DOG KENNEL 0 DAIRY <br /> %A+' 15 HAZARDOUS WAST"E 'n°RATOR 13 CHICKEN RANCH 0 PKG T'REATM9NT PLANT <br /> 0 TIERED PERMrITED FACILITY I7 NOTEIMOTEL M PUMPER TRUCWYARDICHEMTo -TS <br /> in TATT03AWDYPIERCW( : I7 POOUSPA CI LANpUSE APPLICATION SITES <br /> tl MEDICAL WASTE FACII.V)v M OTHER (PLEASE SPECIFY) <br /> 1 . List up to ten addresses in the space above, Select the type(s) of files from the list above py checking <br /> the approplia :e box(es). At least ane file type MUST be selected, Fax to (20964-0436 Ormail to tho <br /> address indicated above, <br /> 2. END will hatil y the applicant N any END files exist. An appointment for review will be confirmed <br /> approximatehl i"we busirless days but no later than tan (10) days after receipt of application. The files <br /> will be hold f( r a maxim Im of five business days for review, Appointments should be scheduled <br /> accordingly. <br /> 3, A file that is a c ivety bei 119 worked on by END staff may not be immediately aivailable for review. A new <br /> application m vi be submitted when the file is available, <br /> 4. Any fife not re turned in I he game condition as released will he reorganized by EHd staff at the expense <br /> of the applica nit, Future file review's by the same applicant may require a $98.00 deposit prior to review. <br /> s. "TENTAT[VG : Lppcintmel A dates must be confirmed with END staff, <br /> 6_ Applications i pceived otter 3:00 pm will be processed the next business day. <br /> CONFIRMED AppO111TME NT DATE TIME <br /> DATE CONFIRMED � _�• _ PHONE FAX • INI 'LALS <br /> REVIEWED fl«S N0 REVIEW DATE <br /> EHa d9SYWi, — <br /> elareppx <br /> TO / T0 39Vd 1N314dInoa vm L ZP : TT 900L /6Z /E0 <br />