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ENVIPZNMENTAL HEAL-7y PALE E 1 <br /> ,!07/2006 12:45 4640138 EHA Lou Num t>H <br /> sCl; p SAY JOAQUIN COIM-x C, <br /> Stockton,HEALTu DEPARTMENT `T}�-OA' <br /> 304 East Wcbcr Avm=, aro Floor, Stockton, CA 95202-2708 w.sjor <br /> Telephone- (204)468-3420 x A7[+(207)464-0133 Vcb; ww�v.sj$ev°�ehd <br /> �aOZ?m5 <br /> PCTBLIC RECORDS TZIF, ASE APPLTiCATT(�l L � <br /> BUSINESst E"CY; <br /> APP4ICANT: (� CnyY� �� TATS <br /> ADDRESS:. l FAC99�911 E ��ca'a PHONE(4' a(o PHONE(21- 411 <br /> 4 <br /> TF.NTATIVIE"APPOIWMEKT PATE:=)! 'u' <br /> (pleat-�e allow 10 boginmm dam ftom da"m at�ppC,cs4fon suumittal•*7er►EQU only'�ue� 1D IN a BUSIMM DAYS <br /> GI CHECK <br /> BOX TC FXPEDiTE REQUtrjST-M.Do FEE(CASH OR CHECK OMY)-REQ e f PRp <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> Electronic O LJst �fAmp-DescriPtton <br /> PHO <br /> hrformatlan <br /> FILE ADDRE�$ EHO USE ONLY <br /> Stmet ft Stree Name city <br /> ., D Unit 1 <br /> 2" if S <br /> 2. Unit 2 \P <br /> unit 3 <br /> s. hoc) ► t_. Unit 4 <br /> 6. t <br /> 7. 1 Unit 5 <br /> 9', lJnit 6 <br /> 10. <br /> Speen Date Range of llrtfsrrnatiOn Requested:Froth <br /> to <br /> ENVIRONMENTAL..HF-ALTH DEPARTMENT FILL-8 <br /> ❑HQu.%R=ABATMA MT t.to WAS—FA1xt(Ur MfZHKxZ- <br /> tpNDmRouNDTA4/K(UST)t�E UttJP Etta(�QP) C1 FOOD FAQT6rky ASTF TIM <br /> HER f,I IcAMUP SITE �QPf H) lREtgtQVAL) ❑ DOG KANHEL ❑ OA17Y <br /> ROUND TANK MWM 0 CHICKEN ROWH >e-WMTEVAMT7PATWWTPISWASTE(IMORATOF. ❑ MOTELM07ML ❑PUMpVRTRUC AARW0Kc Cp.LTDILM <br /> MeD pERMrrrVb FAC1 M M POOLMPA ❑ Lm UsEAP4I1.M'.A7ON SITES, <br /> 0 TATr0WEI0UYPIER0WQ t•1 OTHER(PLEASESPVCPFYI <br /> MsDICALwpsis FACILITY <br /> WEI.I,AND Bt4T'IG P6R1�trl'REGtaRcle Atae AvAIL►�-A FOR RE�lS9VIt �fdONDAY-FRIDAY S:OU Aat-B:OGPt� - 6XC1- roAY�. <br /> ng <br /> 1. List up to tett addresses In the spoCe above, elect the types)of files lrotcl 464-n 3g <br /> above by <br /> (bto theclwaddreth.�e <br /> tR7 LD I�Q�d��k+A�or�'t!1 w l+le d6A 1/".c`- -' <br /> appropriate box(es). At least one file type MUST be selected. - , contact <br /> Indicat0d aboYa, Address Mrigea Will not be accepted -for additional"aistancp wft life addMaes, <br /> the EI-10,AppliCations received after 3:00 ptn will be proaessad the next butine.Z;S day. <br /> 2. The EHA will batify the applicant if any EHD files exist. An appointment for review wili be confirmed <br /> she EHOnaill' ten{40)days 2rfRar receipt of application. The files will be held for a M9-4mum of fine business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is natively being worked an by ERD staff tnay not"immediately available for review. A new <br /> application may bQ submitted when the file is available. <br /> eniretl 4. Any file not retumed in the same conditlon as released will be re rg <br /> $93 00 depEHD ose ptistaff at thR PXPOnee of the revievlt <br /> applicant. Future file reviews by the same applicant mayrequire <br /> 6HD 48-06 <br /> 1 QJ,�41I006 <br />