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LIATincLcarcu E 'f <br /> 1110 LOU HUMPILR <br /> SAS! J IQUIN COUNTYPUBLIC HI~AivTH 'ZVICES <br /> NVIRONMENTAO~ HEALTH 1i IStt3ir <br /> j, ' �.f 1 (04+ 304 EAST WEBER AVENUE,THIR6 FI` 6R <br /> STOCKTON CA 95202 � <br /> k_ I {249} 468-3420 � <br /> i .. l <br /> BLqT <br /> ! Y <br /> APPUCANT BU31NESSIAGENCY _(�WN bo9 <br /> ADDRESS 5 L C�.{y S v i m zIr <br /> S <br /> PHONE 2 3 5F- FACSIMILE 2 3 4 - O <br /> TENTATIVE*APPOINTMENT DATE f 0 ,, 2 0o f <br /> (please give I to 10 business Jaya fraan dge of apparation;suhroit-W) 1 <br /> CHECK @OX TO EXPEDITE REQUEST-Sa7.00 FEE—REQUEST PROCESSED IN 3 r13MNESS DAYS <br /> SIGNATURE OF APPLICANT <br /> ! DATE, f ca 1 r ea 4 <br /> FILE ADDRESS THIS SIDE EHD$TAFP USE ONLY <br /> PROGRAM EL-MENTS SEARCH <br /> 15 `r <br /> it if <br /> i Ik <br /> � f <br /> i� SII I <br /> } <br /> �/ ENVIRONMENTAL HEALTH DIVISION FILES <br /> +� J~ltGI�OUNB TANK(L13T)CI��4tti7P 51IE(I,QP) L7 HOUS}NG ABATIZMENT II Q SOL1O WASTE FAC 1JTY <br /> �r ER CLEANUP SITE(NON4LOP) M FOOD FACILITY !!i � SOLID WAuSM VrAGLE <br /> ERGROUNO TANK(MONJTOMNGJREMtOVAL) ❑ 00e KENNEL IL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ! ❑ PKG TREATMENT PLANT <br /> Q TIERED PERMITTEDFACILrYY ❑ NOTEI1HOTEL C1 PUMPER TRIIQKIYARVjCffEld'IOI ET,. J <br /> M TrOCWBODY P3={t mr. 0 P60USPA ­ 0 LAND USE APPLICATAom siTE9 <br /> 4 [!MEDICAL WASTE FACILiY ❑ PUBLIC WATER SYSTEM ! ❑ ',OTHER(PLEASE SPECIFY ABWE) <br /> 1. Li P J il <br /> List up to ton adds ,,t:s in the Space above. Select the type(s)of flies from the Ilea above by cliecl�ing <br /> tate appropriate bwc(es}. At least orae file type MUST be selected, Fax 464-0938 or iLi fo <br /> address indicated afgoye. <br /> 2. EHD will notifythe applicant if EHD files exist. An ' <br /> ESP any� ppoirttrlerwt for r'BYiew will be pRrrfiw�t>Eed <br /> apftrmximatcly five business days but no tater than tens1p a r.r � <br /> { }days y axe�I e�ipt of a{�pliw:atlt�rl. The files <br /> a <br /> will be held for a maximum of five business days for ravlow. Appoilrtments should be scheduled � <br /> accordingly. I <br /> �p <br /> 3_ Afile that is actively being worked on by EHD Staff May not Ise immediately available for review. A now j <br /> applicatWn may be submitted when the file is available. .� <br /> 4. An file not re <br /> Any turned in the same condition as released kV1ll he reorganized by END staff at the expense <br /> of the applicant. Future file reviews b same y the a pplicant ma ` vir <br /> Y re� e a S s7.Op deposit prior to review. � <br /> 5- 'rENTATiVE appointment dates rust be confirmed with 1=HO staff. I� <br /> 6. Applications received after-3.00 pm will be processed the next business day. � <br /> r 'k <br /> CONFIRMED APPOINTIVIFNT DATE f� <br /> TiiNE� � <br /> DATE CONFIRMEDk <br /> PHONE FAX INITIALS <br /> I I <br /> I t <br /> II <br />