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FRJM : N!3A Env i rcnmeri ta.l PHOt4E h10. : 21jTD 36,j 1229 - alar. 16 2000 10:05AM P1 <br /> SA ", ,)AQUIN COUNT-YPUBLJC HE'ALTH SEYVICES ,�OiG4l4MnEh•L �— <br /> I' ENV1R0NM�TAL HEALTH CIVISiON <br /> -1a4 EAST WF.BERAvENu1E,-rH1RD FLOatt <br /> STOMCTON CA 902= �•► <br /> F'11aLCr7 <br /> Mm €*-m-m- RF 222- APPUCATION <br /> +'ir'PLZANTILa <br /> 1. <br /> �alae:ss 22. hl. �ruaur�,�AaEIwcT '.,t � <br /> PHONE c+V 1 s C <br /> TFNTATjVz,,APacnm't ENT OATS <br /> (Pl4saa grv.7 to y0 c�xltHaL a►l,rr�arr� Wer TPAE <br /> CHECK 13OX TO ExPED r E RE-QUEST-$7 .00 F"_REQ-•ST !VA''�,/�o <br /> SIGNATURE OF AAFUCANT > st 114BUSINESS CA" + <br /> 3 q17�Ot <br /> PAS <br /> Ar 2— <br /> t E•. v. a�, p ,,,., 5 <br /> l!"( ONMENTAL HEALTH DINI,%ox MES <br /> UNDERnROUNO TANK JUST)CLEAMt1P 3A'S([.dpi ❑ 4DUSING AD ATEUgNt p <br /> oT�CWAUUP SM iNW-IA p}'' �WASTE FAC4ATY <br /> 1K+1�IMI)OM TAAK(=NMWU* ri MWNAL) a �.FOM TT 4 BDUD wasre vIEN� <br /> HAZA�g WAST8 GViERATOR Q ummv <br /> T'Utri PER"TTED XA L I:7r❑ �� P4fOr YRr.ATIWMgtPLANT7ATrooleCDY p�1k* PUMPER TmUCWNARircfW-yT0A-FSQ IGAL WASTE FAGxY R <br /> p <br /> OLWA <br /> © FUEt„IC WATSR SYS tANU USE APPI."IMN SnES <br /> M CI L3T116tt{PI.Tic14RP Sittr-Y ASpY£�} <br /> 4• Llst tip to ten Ruddresras in the rrgeco above, sailed tho <br /> tyPe(the apAropriats t)nx(as)_ At leant onQ 6046 type MUST be seleotedf t143s t'rant the list aboYs by chucking <br /> e <br /> Em <br /> 2. MD will notify the app jCant jr,any eta-Ales axlat. An <br /> +�Iaroximately live business sfayx lwt rib I;RW thin tett 0 days aptar r0ceapp0hibnerg for f t of a i#e rArstimr� <br /> W;u be hold for a t'rtsxlrnum of five business Cat's for rovtt A A ppl;catit�n. The tubs <br /> ac� 91Y. l ntmQnta should bb arhedUled <br /> 3. A file ttlat is actively b©ing warkad on by Zia staff m not be Imtn <br /> appiiextlort rrmx bs 4Ubrnfktcd when the flto is avaaablo +�tiYatteiY av�allabtai For ravhm Anew <br /> Q* Any file not ratUmed'n the"me Gandlt pn as released wl11 be <br /> Of the VOIGARL Futium life rlrvie�b tete. rt►or$anl�dY EHO StIl"at the aXpense <br /> MNTA;fVS a aj Y same applWI E may <br /> require a$78.00 dtpoait prior to rzview. <br /> S. � �ettt tl8tea mcs##ee oGnflrnrae!��Et3D static. <br /> Applicttflon$rai*lved after 3:00 prn W"'be prOCUBaed Ito next bua4mss clay. <br /> CONFIRMED APPOINTMENT DATE <br /> TIME <br /> RATE COMPIItly xt 0 PHONE Fax <br /> IN MALS <br /> REWEVYED YES NO <br /> tls • REVIEw DATE ' <br /> TOTFL P.01 <br /> I <br />