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+9168520307 <br />-30-04 13:34 From -TTI TETRA TE NC /� <br />c�wV r cV AN J QAQfJIN COCQ U 1` + + <br />Y <br />v�DD NylgpN�V[FNTALHEALTH DEPARTM ? <br />'J <br />304 $ WebcT Ave 3`d FlooT ST°ckton, anjOaquinancon <br />. <br />31,31- 3 <br />0 2W9) 468-3420 Fax: (209) 464-0138 Web; www -COs _' <br />APPLICAKT= <br />PUBLIC RFc0"' g LIIA.SE <br />RUSINESSIAGENCY: <br />ADDRESS: _.. FACSIMILE: <br />PHONE: /( 'rime,7ENTATIVE'APPpINTMENrDAT� a ---�— — <br />Lpiedse allow 10 business days from submi <br />date d aPPIIcaGan <br />�-t rtEQUEST RDC SED IN 9 eUSINFSS DA <br />0 CIjFCK I3OX TO EXPEDRE R8 E'T - S93.40 FEE - <br />SIGNATURE of APpEICIINT <br />P.03/03 F-108 <br />Iq <br />Q <br />6 <br />Airs <br />nI Use Coy <br />UNIT <br />0 Unit 1 <br />[] Unit 2 <br />Unrt3 `'Y <br />om <br />unit 4 <br />Q unit 6 <br />TH DEPARTMENT FILES <br />ENVIRONMENTAL HEAT s p WASTE FACILITY <br />A HOUSING A9ATIEMt p SOL O WASTF VEHI� <br />UNDERGROUND TANK IUSTI CLEPNt1P SITE (l�I r3 FOOD FACILITY Ll DAI Y <br />Ups" (NON-LOPI ❑ DOG KENNEL ❑ P TREATMENT PLANT <br />�N�p µGROUND TANK iNIpNRORINGlREaIQVAL) A CHICKENTtmo" ❑ PER TRUCKIYARDICHEMTOILETS <br />A FiAZARP WS WAM s"ERATDR M MOTEUHOTEL p USE API+UCATION SITES <br />❑ T11 REp PES ❑ OTHER (PL�E tpEc a checking <br />PA <br />❑ TATTgggooY PIERCING ❑ PODS <br />L7 MFIACALWASTF FACILITY t of files fD 09 41tst-0aDa orpya t t e <br />hist up to ten addresses In the space above. MUST be lect the WPO") F <br />the appropriate box(es)• At least one file type ointment for view will be confirmed Tilos <br />-harass ipriate d__ ab°°@: 1p to t after r ipt of application. <br />ENP Y�i�uf% the appllcant tf anyp Hca later th n te tp 1 y olntme is should be scheduled <br />2. appr=lmately flYe business days s for review. ADP <br />will be hold fora maximum of five business day <br />accordingly. o ed an by FMD staff may not be immedta ly available for review- Anew <br />by ftp staff at the expanse <br />3. Afile that is actively being w rk sft riot t° review <br />appNwtion may pe submiaed when the file Is rete able. require $93.00 dePo p <br />the same applicant may req <br />4 Any file not returned in the same condition as released will be reOrg? <br />of the applicant• Futgstaff - <br />re fele reviews by <br />`TENTATIVE appointment dates must be con Q�Ssednthe next t bushes day, <br />f. Applications received aftat 3alD pm will be P <br />'TIME <br />GGN1IRMEf3 APPOINTMENTDATE INITIALS ---�—~ <br />PHONE FAX <br />DATE CONFIRMED NO REVIEW DATE <br />REVIEWFl) YES <br />