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� lJ SAN ,1Q�UIN COUNTYPUBi-IC �F_ALTH SF-Om4NCES <br /> :nMMENVIRONMENTAL HEALTH DIViSIO7 <br /> THIRD FLOOR <br /> JUL d 3 2400 304 EAST WEBERAVEI�ILI>w, � <br /> STOCKTON DA 95202 <br /> ENVIRONMENT HEALTH <br /> (289) 469.34211 <br /> PERMIT/SERVICES PUSiiC RECORDS RELEA E ARP -!CA ON <br /> �,� „Y�,.13LISIFiE55IAGF,.tICY � � �..• <br /> APPLICANT <br /> PHDNE 3 �— <br /> TIME <br /> FACSIMILE <br /> TENTATIVE-APPOIN714IF-0 DATE <br /> (please give 7 to 1—0b asintzdays fromn datb of application s015mittal) <br /> 13 CHECK BD%TO CXPI:OtTE REQtjMT-$7&00 FEE–REQUEST PROCESSED IN a BUSINE55 DAYS <br /> 1�1GNATURE OF APPLICANT <br /> -� FILE AD>7fLE5S TRIS SIDE EKa STAFF USE ONLY <br /> PROGRAM ELEMENT$SEAASC <br /> I G 1nGo Ih 57, [6ctan <br /> b .t SI• �a 41 �; L rim 3;zb <br /> W, c r 23 I 35 z(o <br /> 5 i W, Ckar ti✓ W U 4 <br /> 3 Z <br /> a05 r Ccs 5trr T <br /> ENVIRONMENTAL HEALTH DIVISION FILES A <br /> © HOUSING ABATE EST 0 SOLID WASTE FACILITY <br /> UNDERGROUAIo TANK(UST}CLEANUP SITE(LOP) M F0017 FACILITY ❑ SOLID WASTE VEHICLE <br /> -LE <br /> OTHER CLEANUP SITE(NON-LOP) 006 KENNEL ❑ DAIRY <br /> 17 UNnFRGRoUNo'TANK;MONrrORINGIRI:NOVAL) D DCHICKEN RAI'ICH 0 pj%TREATMENT PLANT <br /> C2 RAZAR.DOUS VyAS1'Ie.GENERATOR Q M141CXEOTEUiDT6L » pUMFERTRUGKjYARuic;H_M TOILETS <br /> ❑ 7IEft8D PERhhII TI:O FACILITY C3 POdUS¢A 0 LAND USE APPLICATION SITES <br /> M TQ'TTOWBODY PE.IRCINO 0 pUBUC WATER SYSTE.M O OTHER IPLEASE SPECIFY ABOVE) <br /> C7 MEDIGA>.WASTE FACILITY <br /> 11 List up to ten addresses in the space a 209 4 4-013rai!to bove. Select the types}ai files from the IISt above by altieathe <br /> the appropriate boxes). At least one f(e typ¢MUST be selected. Fax to <br /> s indicated a bite. <br /> 2. EHI)wili notify the applicant if any EHD files exist. An appointment for review vuiii be confirmed <br /> approximately five buslness days blit no later than ten(10)days atter receipt of application. The files <br /> will be held for a maximum of five business days far review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actiyely being worked an by EHD staff ritzy not be immediately avallable for review. A new <br /> applic2tion may be submitted when the file is available. <br /> 4. Any file not roturn&Ld in the SaMa-condition a,s released will be reorganized by EHd staff at the expO=0 <br /> of the applicant_ Future file revisws by the scale applicant may require a$78.00 deposit prior to reV19W. <br /> 5. 'TENTATIVE appointment dates must be confirmed wlth EHP staff_ <br /> 6; Applications received after 3:00 pm will be.processeld the next business day- <br /> Ci <br /> ay- . <br /> CONFIRMED APPOINTMENT DATE TlAllS <br /> �A'iE COhIFIRMED - PHONE FAX INITIALS <br /> �F_VIEWZD yet REVIEW[SATE <br /> TOTAL P.01 <br />