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05/08/2003 13:50_FAX U 002 <br /> VIC E S <br /> !'SAN Ja. 4UIN GOUNTYPUBLI HEALTH <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENU •THIRD FLOOR <br /> M A (1 2003 STOCKTON CA 202 <br /> (209)468.342 <br /> Jq; ::.,L,PUQL1C RECORDS RE. SE APPLICATION _ <br /> APPLICANT ��''--` ` "' � BUSIT ES VAGENGY <br /> ADDRFSs lv'� V <br /> PHONI% <br /> PAC51MiL E �I L. Tiff •V��,���.. <br /> TIME �Il <br /> ` .4k- <br /> (EAJjATWE"APPOINTMENT DATE tl fan sub�mtt4al} <br /> (Please give 7 to t0 6uainess days from d t e of app to <br /> 18.00 FEE--REQ OGE 91:b w 3 Su%NESS PAY. <br /> . •` 3 <br /> CHECK Sox 70 IEXAlcDrre REQUESTS �8 !lam G any <br /> DY--�-f- <br /> SI OF APPLICANT `'�"-;- �y <br /> THaS•S�DEiD::TAPE USE ONLY <br /> FILE ADDRESS PItUC31?ANN1?=LEMEWS SEAHCH <br /> an os opo �► <br /> � 95 <br /> b 1 trap LLLv►c- , La�]i � G4 <br /> 4 - <br /> ENVIRONMENTAL HEAL H DIVISION FIL1--S. <br /> ❑ HOUSING ABA FMENT 11:1. ::iOl.)1-)WASTE FACWry <br /> c/UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACIL l5'.30bo WAs'rE VEHICIA <br /> ❑ OTHER CLEANUP 9RE(NON-LOP) 0 DOC KENNEL M DAIRY <br /> IrUNDERGROUND TANK(MONIToRwwREMOVAL) O CHICKEN RANCH 1:1 pKG.-rREATMEr;T PLANT <br /> O HAZARDOUS WASTE GFENERAXOR ❑ M07FV1{OTEL 13 PUNTER TfiUCr4YARDICHF-M TCILErS <br /> 0 TIEJiEO PERMITTED FACILITYt3P00jJ5PA E9 LANf1 USE ApPI„ICAT;ON$rrf�S <br /> 0 TATTOOfBODy PEIRCING O pUVLICWAT SYSTEM ID OTHER(9LVASe SPECIFY ABOVE:) <br /> Q NaEGICAL WASTE FACILITY <br /> �. List up to ten addrosses in the apace above. Select the type(s) of files from the list above by cittckin�l <br /> the appropriate box(es). At least Dale file type MUST be selected. ��;•�..2d�_1.��-�3 Or tall10 the <br /> ddr ssdisc eve- <br /> oirrtxnsn$for rE:view Will be t onFirined <br /> END will notify the applicant if any END files exist An app _ <br /> approximately five business days but no later than a (10) <br /> wdaEyts iter to ItS should pbe schedulle�filgs <br /> will be held for a maximum of five business days pp <br /> accordingly. <br /> 3, A fila that is actively being worked on by END sta may not be Immedlainly available for review. A new <br /> application may be submitted When the file is aval able. <br /> el. Any file not returned In the same condition same <br /> rale s:lic�itlbe nia r re.uU re aod by$8.0 p_HV Stsff at the expense t print to review- <br /> of the applicant. Future file reviews by the same pp • Y <br /> 6. *TENTATIVE appointment dates must be confirms with EHA Stant. ;...;� <br /> 6. Appllcatlonss received after 3:00 pm will ba processed the next 1,u=I'Iness----da <br /> I CONFIRMED APPOIi TMENT DATE TIME ---�.��" —�---- <br /> PHONE FAX INITIALS <br /> DATE CONFIRMED <br /> REVIEWED• YES NO REVIEW DATE,..= <br /> eH 00 14 0=4M TOTAL P.02 <br />