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12/I /2003 I7:54 20 ,'9-2225 A r MODESTrO�AT( PAGE 02 <br /> q <br /> ISA �1O,C7.QUI CouI P triV I.VU NUM <br /> s ; ENVIRON1VIEhI'TAL HEALTH DEPARTMENT <br /> 304 E Wobcr Ave 3d Floor Stockton, CA 95205 f ` <br /> {209}468-3420 Fax; (209)464-0138 Web:www.co.um-jvaquin.ca.us/ehd <br /> 20� <br /> PUBLIC RECORDS R.ELFA.SE APPLICA110N <br /> �14� 14 4es <br /> APPLlCANT:�. rn ar, _ 9uslNESB1NQEHCY: <br /> ADDRESS. L~On�. G�I�!I � �`Q,_ -O <br /> PHONE: FACSIMIi.g. <br /> TENTATIVE'APPOINTMENT DATE: CRT? Time <br /> {Ply allow 40 b�wlrwsa days eom of p on subin" <br /> CHECK BOX TO EXPEDITE REQUEST•593.001FEE-REQUEST PROCE38ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Deparbn.nt use only <br /> UNIT <br /> FILL ADDRESS <br /> 1, arm A6 Unit 1 <br /> 2- G <br /> d 3 Unit 2 <br /> 4, aa.a <br /> a. qo* Unit 3 <br /> a <br /> a Unit 4 <br /> t <br /> ex <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE.(LOP) ❑ HOMING ABATEMENT Q Soul)WASTE FACILITY <br /> THER CLEANUP Srm(NON-LOP) ,. 0 FOOD FACILITY ❑ BOI.@ WASTE VEHICLE I <br /> NDERGROUND TANK NONITORINGn"OVAL ❑ DAIRY I s <br /> �"FiAZARDOUS WASTE GENERATOR ❑ C�KENNRAf+ICFI ❑ FKG TREATMENT PLANT +. <br /> C7 TIERED PERMITTED FACT ER Q MOTEL►HOTEL ❑ PUMPER 114UCIVYAR11011 TOILETS <br /> Q TIERED P RMI00Y TE FAC1CING ❑ POOUSPA Q LAND USE APPUCAT[ON SRES <br /> 0 MEDICAL WASTE FAGtLITY ❑ OTHER(PLEASE SPECIFY) . <br /> 1. List up to ten addresses in the i�pace above. Select the types)of files from the list aboveby oheckin4 <br /> the appropriate box(aa). At least one filo typo MUST be selected. ; <br /> �1: <br /> 7, jdC will notify the applicant H any EHD files exist.'An appolntment for review will be conflrrned <br /> approximately five business days but no later than tan(10)days after recelpt of application.,!The file's <br /> will be held for a maximum of five business days for review. Appolntments'ahould be scheduled <br /> accordingly. <br /> 3. A fits that Is actively being worked on by EHD staff may not be Irnmadlately available for review. A ne <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same ccndlticn as released will be reorganizes[by EHO staff at the expens <br /> of the applicant. Future fila reviews by the same applicant may require a$93.00 deposit prior to re0w <br /> 9. "TENTATIVE appointment date's must be confirmed with EHD staff, <br /> !#. Applications received after 3:04 pm will be processed the next business day. <br /> CONFIRMEDTIME <br /> APPOIMT•MENT QATE <br /> DATE CONFIFIMEG PHONE FAX' �_ NITiIKC,g k <br /> REVIEWED -YES Na REVIEW DATE. <br /> s,ro.a.az�os • . S <br /> sngrim <br />