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R . . ,� <br /> �smioa '' 3 <br /> ea MW Fk�0i�1�"1. •'� euirlta� "�' •_ <br /> ' <br /> 4SAN <br /> y /� �[ []UBLICl TH�uEALTHSERV[Ct=, Opo QUIN COUP■ r A.11. DIVISION <br /> AdWENVIROj+IMENTAk DEQ' TW FLC30Ft 1 a` <br /> 304 FAST WESER AYE IU>~ <br /> .° sTOrrK70N CA 9 520 2 <br /> (209)4$8.3=420 , <br /> PUBLIC RECQRUS RELEASE APPUIC ION <br /> aVF <br /> ��,E: LIGANT n� 1.! is wr tFSIi�lE.45rAGEHC`� C <br /> iAj RESS L4 1 <br /> s <br /> 5qL! FA0*1MiLE <br /> R; ONE { -CJ <br /> L7 Tie <br /> f r -rENTATiVE'APPOINTMENT DATEp 1, 7 zubmUtar) I <br /> ;ptaagA dive to 10 usineas da Scorn date of Ip•G <br /> e I-- <br /> `lsi CHECK tiox t0 fx?EDrm REQUEST $$7.00 FEE--REQUEST PROCESSED IN a r3LiS1NF.S5 DAYS <br /> DATF <br /> 'V. <br /> SINE END KLY, <br /> t~�' ;t. <br /> 3PROGRAM ELEMENT'S SEAttGH <br /> 1=1t.E ADDRI=88 . <br /> Eia r R4• Gh `45Z 2 52 <br /> r I <br /> .T. ' ` P.S ti Kt <br /> 5­11 1110E. ;c to,r R� Lard i <br /> I= fb It ke <br /> p�`i �d I <br /> -10c.ke <br /> J"� + 00 Ecc4crn <br /> ido �i c o sr �Z• <br /> ENVIRONMENTAL HEALTH D)Yl5lON fii•1=S ; <br /> r , r jd sOUD WAsT�FACILITY ' <br /> ANUP s}TE.(LOP) tl NOU51NOA8ATEAsEHT <br /> tiNO TANK usT)cLECl sOt.la WASTE VEHICLE <br /> , <br /> ���i n FOOD FACILTI Y 0 DAIRY <br /> O'tiTteKCRLEAN4JP SITE{:fool-�oP1 D DOG <br /> JQ pI<a TREATMFNf PLAN <br /> 31�lUS WC3U5 Np YANK(l418N1TOK)t1GIREIr4O�At3 puMpF_R'CRUCIUYARlVC F-M T0ILF-T5 <br /> 1Rua1}BVVASTE GEN1=ftATaR p MOTELIHOTEE. i- <br /> 'If[�RaD p9MITTED FACILITY o pb01 SFA 1 A11C USE APP AVON $ <br /> TATTDIDISODY PEIRCjNG �} pUBL1G WATER SYSTEM D OTHER(PI. AST"SP>?Ci ADpVlr} <br /> Mk�JCAL WASTE FACILITY 'e ctte�kl <br /> e s 0#flies from the list above y 8 <br /> 1^ist u to ten mddresses In tine space above. S$1ect;tha typ f 3 4 . i r� <br /> r. the apQraprSate box{es). At least arse Ellie type MUST be selected. F t , <br /> ':` `.address Indi c�I� Y airltment for seYiew wall be Conor ned <br /> P-HD Will notify the applicant If any EFID fits exist. An app da $Stec receipt of appilcaGu . The files <br /> approximately five business days but no later than len ie Y ointmerrtO should be scheduled <br /> vvi.l be held for a maximum Of five business days flat review. App <br /> ecc,trdingiy. <br /> Afi1E That#s acti�rafy being worked on by EHD staff!nay net be Immediately available for rvlew. Anew <br /> applie%trots may be submitted wh*n the file is avallabie. <br /> AhY Eric flat returned in the carne cal�dit}on a8 rere"ed will be re0tgar<Ix4d bar EHD stall rt tits expense <br /> .,?6 of the applicant. Future file reviews by the some applicant may require a$87.00 deposit p>(ior to review. <br /> *TENTA i;VE appointment dates must be confirmed with E14D staff. <br /> Appllca6&,-is received after 3:00 pm wilt bt proces +xd the next business day. <br /> `66NFIRMED APPO1r�irMENT QATI~ 'tjME <br /> rAc.s <br /> TEA CONFIRMED ONFIRMED PnUNi± FAX IIIffT <br /> r%r'%4MN►lrr% err fin 12M1111I nATO i I <br />