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Q5-11-1994 03:46PM '-'QM TU L41SS 789131 P.02 <br /> Sart J'OAiQUIN COMM <br /> PMC HEALTH 31MVICFS ••� <br /> ENVINTAL IM"T$DIVISMN 517/9 y /L4v`� '= <br /> �MOMA <br /> PUBLIC RECOBDB MEL A6n APPLICA►MN <br /> APPLMAM 37-irf 0tA itQE*4PHONS INo <br /> (��(�{ AIDME �lA�'�So.tArfr�{�Pt}i. t.1tAbwyo�ri �32or� P.*cwp CA liz. <br /> Q/�-}�t4��{ <br /> NO <br /> ' ADDRB85 <br /> doom <br /> MT R AQnRF TRAD ArEW= D <br /> 104 a W.COMT99,WhY BLE, W sAr-8S <br /> 3F 1045 W. r-A*Mt WAI (sR WE 4A#M(A;1f46 (ft�4MNoriE ktJt C0lJMvc vJ) <br /> tt2a W. CAKTm 4 M . ��_ Mta CALTRhuDA <br /> y� 12..34 W. poom wm Ck5e Ptlwm lata %IilwE$T <br /> i2145* W. GiktrM W*h S.14. EdulpK ti"o3Be A,4 <br /> IK 1323 W. i c W" SmAtf <br /> j�Lt W1 Ct+K_-tsm Wkt INLr JWrl6u'MAdgdf.c�•l�k+r(--- - <br /> x -w silt--Npci pw �r--.Qa Srr�wrw <br /> ) 4I7-440 W Irry bZ lK 3,T..2G SYac a ag Sc� <br /> THIS NUIIC$ IS sUmECP TO THE REQUMEUMM XL7MWTMMD XN ITM PUBLIC HEAL'M <br /> 9ERYIt�S!>�TVIRCgibG�7 X'ALREALM DIVLSIOK(;ice PC iCY T,CkMMiANCE CODE OF SAN <br /> 7aAQMN CgUtrff. MM vEM AND SERVICE CHARGE RE90LY3' M43. STATE WATSLL COUK. <br /> GOVIRNMENr CME AND TRK EVIDEZN[$CCDI. <br /> 1. A MAXI WM OF-DEN(10)PREIMH Aj7DEt MES PER REQUEST. <br /> Z. PUBLIC FUMMSCMMS REVIEW ARE BY AP3't7FNTMI.7d3'ONLY, ARE <br /> ARRANGW BY CALLING (2N)4694 40. OFFICH HOURS FUR APPOMMMM ARE SCEEDULEI3 <br /> MONDAY THAU FRXDAY EXaMDDNT HUImAYS,8.-00 A.3L TO 177-W NOW AND L-00 P-AL TO 4:30 <br /> P-M. <br /> 3. A PVB=REC?RDS PMXASB APP11CATION ANDA O SET QF VMM <br /> I8 RBQUMM. DEXYMS WnL US R]Gx47W ED TO THE APMC NT IFSCORDS ARS <br /> NOT AVAELAP R WIMM MM CI3SY M OF ]am <br /> 4 TSE ABOVE IDHNIMED DEPOSIT IS APiPLM)TOWARDS 7MH TOTAL PRL&REVMEW FM <br /> CTIARCQ TME BALANCE OF MM CHARGES ARE DUE AND PAYABLE TO SAVMWDW TSL - <br /> DOCXMENTM. <br /> 5. FUBIACTU.5SaMCORDSHOTIMITENWINIM SAME CONDMON AS RBCII M'SILL B.8 <br /> CORRECMD NY 'LRS MM STAFF AT TAE EUEM CF TIM APPJdCANT. UM ADDl CMAL <br /> SERVICE WILL M MI TO TBE AM KART POOR PAY11MiT. <br /> 6; . O$MGWAL PUBLIC FILE&TXCURDS SSiALI.NOT BE PM40VED FROM TAE FIM PMUM2 <br /> SiGNA MM OF APPLICANT AMW 04 114. DATE S-IlZ/ <br /> SMNATtMOPR� O"TCrA.. DATE <br /> Eff 00 t4(�yY IZl9z) <br /> TDTAI. P.02 <br /> MAY17'0�4 <br />