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09/27/2005 23:29 863918 RHINO REALTY PAGE 01 <br /> 09/28/2005 09:51 4840138 ENVIRONMENTAL HEALTH1 <br /> PAGE 0., <br /> Is]1J( ID SAN�OAQUMCOUM <br /> . ONMNTAL REALTH DEPARTMN'z <br /> S E t2 0 + 304 East Weber Ay�i e, 3"Floor, Stockton,CA 95202,2708 <br /> `t'elephocez(209)4683420 Fax:(209)4640138 Web:www.sagov.org�hd <br /> ENVIRONAAENT NEALTB <br /> PERMIT/SERVICES -PUBLIC CO �RELME APPLICATION <br /> ,APPUCAW, be2JA4BVSZtiESSrA®Eflc'f: <br /> ADDRESS: <br /> PKQ@iE{i) pNONE(�: 3 l AGSl6dit 8: <br /> ATIVE"aP DAM <br /> (Pkase r9ow 10 buslnm dos f o d*of&PNcatbd RUNaftl-•i'enft"only mutt be CoKintoa) <br /> C3 WeM Box to STEDM RECMST•03M FM(GASH OR CHECK MY)-RP-QU6ST PFtOMS=IK 9 s !t Mr tkAYS <br /> r SIGNATURE OF APPLICANT DATE -- <br /> tyf1R D ott ®Ucdt 1 x • tic�lt UM!a ®lint! unite other(electroN�si <br /> FILE ADDRESS EHD USE ONLY <br /> . �sbreec� • street Kam <br /> 3, ( fA• �J� <br /> a <br /> t7. . <br /> 7. , <br /> 8. ' <br /> 9. <br /> Spedfio Dac#0 Range of Infamtaaan Ret#tteSted:From f7 to � COPY <br /> OMRONMEN"AL HEALTH(DEPARTMENT HUES �I <br /> T p-APl 10 FCQo FA19 ToeWASTs Fu�utYN cis <br /> FoaoFa�..trr ," T� /�. <br /> � <br /> 0 T ova Q Doo t 00M a 1n( Atrxt'l heat to POM <br /> t . <br /> • W1�StEG�aAtott ®�, ® TaaavY To�'ra • <br /> FAcurY USE Aef4�nroksm <br /> p�qW. 'C1t}o�otJsrA • <br /> 1Zrft MWAsrEPAca.ttY f CSRtPH ee <br /> ' �.Afm SE'P''RC P�tett7 ME 1AYMJU�tE FOR R,EYIEw'• tAYY A;Q411M-6S40PM + f MAW- <br /> el List up to ten atddresses the spec®above. Select tho.tylie(s)of Cies from the list above by ebeeldn4 the <br /> app box(es). At least one file type MUST be seleatA4. Etc to 109. 4 188 as maft to the address <br /> lIn W above. Address ranges will not be a�csepted M for Addloonxi assistance wN fila addta�sscs,car�tact <br /> the EM,App etoons received offer 3.04 pm wlfl be processed the next business day. <br /> 2 The EHIO will 60W the applicant If any END flies exist. An appointment for review W111 be confirmed <br /> 4pproxtmately ten(14)days after recelpt of application. The tiles wfti be held for a maAmum of"business <br /> days for review. Appotn Aer6 should be scheduled accordingly. <br /> 3. A file that b activety"llig worked on by WD staff m"not be immediately avwlable for review. A net+► <br /> application may be submitted when the file li�8l1M IR1314. <br /> 4. Any file not returned In the same condition as released Will be morg4nt12d by FZHD staff at the expensa of the <br /> applicant. f=uture file reviews by the same applicant may require a$93,00 deposit pftar to review, <br />