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u <br /> +Wk 20'39Ud "ki101 ** <br /> .v��a uvv irt�ivriuvi,�l nrya 1'i-1VG -. <br /> HEALT <br /> c � I,\ NVIRONM NTAL HEALTH DIVI� n <br /> 3g4 EAST WEBER AVENUE,THIRD FLOOR <br /> SEP 1 2 zoo STOCKTON CA 95202ni SEP 1 2 <br /> (209)468-3420 2002 / 0 <br /> iC CORDS RELEASE APF�R, <br /> APPLICANTPE all"I BUSINESSIAGENCY_ �S1 PERMIT�SERVICFS <br /> ADDRESS T'2�fjiO�S Tiae,wa4ty <br /> ``,, d <br /> PHONE 61Q 3 0V FACSIMILE 510 - 3 - 7 <br /> TENTATIVE,APPOINTMENT DATE IT, '�L TIME /b -(�J <br /> (Please plus 7 to tosiin s 0M II'Of* p anon aubmltta0 <br /> CHECK BOX TO EXPEDITE RE ST.$8100 F REQUES OC ;? BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH O <br /> S R i 'G <br /> V1 �O c <br /> '-,w to c <br /> — v ' hes ? <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Cl HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Cl HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ' ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTO WDY PEIRCING O POOIISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY Cl PUBLIC WATER SYSTEM M OTHER(PLEASE SPECIFYABOVIE), <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the <br /> address indicated above. <br /> 2. CHID will notify the applicant if any EHD files exlst. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review, Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$99.00 deposit prior to review. <br /> S. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME, <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ealoo. <br /> :TT z0ez TT d3s <br /> z0 z0•d 8£T0b9680ZT 01 ad 9e <br />