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PAGE 01 <br /> 11/28/2006 10:59 1310791 'l1 PAGE 01/01 <br /> n } 5 2094640138 ENVIRDNMENTAL HEALTH tHULu�snuN+ee <br /> S kN JokQTJIN Cot7N Y <br /> oro DnAt; x 570NOV` 30 Floor.Stockton,CA 952022708 <br /> 304 East Weber AYer1Ue, <br /> ENV!RONMEW HEATH Telephobeo(209) <br /> 468-3420 Fano (209)444 0138 Web:vnw+ ggov'orr <br /> PERM!T!S .V.0 <br /> pUgI,XC CORDS RE'I� AST QrJ'X'T zGATXQ <br /> BUSINESWAGFNCY: <br /> APPLICANT: — fn� <br /> 00 ( o ' rAoMMILE: <br /> PHONE <br /> ((1:): w <br /> A 4e 3`6 A" o PHONE C2): . <br /> ' PHf <br /> TENTATIVE"APPOINTMENT DATE.: date of applica�sulmrlttal rar+talivu <br /> Dn1Y•must ba cpdinned) <br /> rtue a9ow 10 business days Rom CASH ft CHECK ONLY)•REQUEST PROCESSFA 1H 3 8U91N 99 DAYS <br /> 0 GHMKIOOYTOE7MP n`EREOUES $ &00FE ( DATE <br /> SIGNATURE OF APPLICANT <br /> Electronic Information: [j List❑MAP'DBscTipUon- <br /> EHD U E ONLY Unk1 <br /> FILE ADDRESS <br /> WWI Street Nama 1 v�S T- <br /> Q -t �1 untta <br /> 1• gars th'nek�1-� t r usr <br /> I <br /> 2. -1 Ura 3 lI <br /> 3. Lo S C oilerRAt� usr <br /> 4• 22 VSa�erloo r unk4 <br /> ll ' D <br /> 5. l� <br /> 7. DEC, <br /> -- - <br /> - - -- ✓3ll Una6 <br /> 8. �f <br /> to <br /> specific Data Range of info�mat on Requested:From <br /> ENVIRONMENTAL HEALTH DppARTMENT FILES <br /> OHDusrxcMAreMa+'T13 DARY WASTE MeSTEPAC0.ITYNElnC1F <br /> hLUKDaRDROUND TANK(LS CMNW SrM(LOP) ❑FOOD PAM" 13 DARCY <br /> ZSOMMCLEANUP Sm OCON-LOP) ❑DoanNNEL ❑WAsTEwATERThaATKNT PLANT <br /> �•UKDERapouNo TAKK(MDNm7RnIcpMoVM" 10 MjamN RANCHtn MTQ"TS <br /> fig, 5WAftMGtF9Mt R D LwoUBEwa^NARnfOBE <br /> �� FACMY ❑MOTEUHOTa4 1]Uu+o USE APPLIGT�$RFS <br /> tal,T1E14ED PEM!IrM O POOLi9PA <br /> 4 TATTOOIBDDY"KCINO - ❑On1ER(PLEASE lrroFY HDUDAYs. <br /> ElMEDICALWASTE FACA.ITY MONDAY-FRIDAY 5:DD AIL6:OOPN E%aAroR7D <br /> WELL ANC SEPTIC PFRM.n RRCORPB ARRAVAII.ADLE FDR REV16W ^ <br /> Space above. Select the types)Of files from the Ilst above by checidng the appropriate <br /> 1. List up to ton addresses In the Sp FAX to )454- 30 ar mall to the address rndl t?d above._ Address <br /> box(Qs), At least One fife typo MUST be selected. <br /> ranges wtll not bo accepted^for additional asclstance with file addrassaR roofed Uro fiHD APPllcations received r <br /> 3:00 pm will be processed the next buslnass day. roximataly ten(107 <br /> 2. Tile EHD will notify the appilcam if anYEND fltea ex4ct. An appointment for bu,si will ba s for r lad epp <br /> days attar mcelpt of app11 on. The fllee win be held for a maximum of flys business days for review. APPeiMmDtTls <br /> should ba aehedWed acc0rdln(JIY- for may be <br /> 3. Afile that is actively being worked on by EHL)staff maY not be lmmediabolY avallDble for review, Anew app' <br /> submitted when the fila is available. - staffIcant. <br /> 4, Any fill filet raturnrav'jowsd in the some <br /> the same con ant m Yrequlre a$95.00 dep sit priorto review et the expense of the appl <br /> EHD USE ONLY <br /> [no news 9l1 <br /> 1 <br />