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y 1 <br /> aWk Z0'3 d -b101 >I<�kLot u1Y�1[Llw'I�IY I HL ..'.L i n rA= KJl <br /> rrli�.l1:Y CIY GU - - <br /> o <br /> EaliARONIVIENTAL <br /> IN COl1NTYPUBL:IC HEALT <br /> HEALTH DIVI9��[�/J <br /> 3P4 EAST WEBER AVENUE~,THIRD FL OR v �� <br /> SEP 12 ZOR STOCKTON CA 98202 <br /> (209)468-3420 SEP Y .2 2002 , <br /> N CORDS RELEASE APFUH <br /> APPLICANT f a Y1 tlUSINESSIAGENClY <br /> S PERM!T/SERVIC S <br /> ADDRESSS /P -' JOJ 2T� W [ Ill <br /> A] <br /> PHONE 610 — FACSIMILE 610 3. r <br /> TENTATIVE•APPoINT1u awr DATE o� TIME / <br /> (Pleas*siva T 10 hNsinems am d&M <br /> 1of s !a c41Gon submittal) <br /> 13 CHECK 130XTO EXPEDITE RE ST-S89.Ot1 F RE4 IPS OC SED[ gll$!NE$5 DAYS <br /> ,SIGNATURE OF APPLICANT DA'Z'E <br /> v <br /> FILE ADDRESS TH &ICE EtiD STAFF USE ONLY <br /> PRGGRAM ELEMENTS SEARCH <br /> v1 h, r-e,446#,- I i4vt4 r a hoV z <br /> t <br /> W-109 to. <br /> Lo <br /> -700 k- <br /> C ` r r. Ayf, <br /> I <br /> is <br /> ENVIRONMENTAL.14MTH DIVISION FILES <br /> UNDF-RGROUND TANK(UST)CLEANUP arm{LOpl [3HOUSJHG ABATEMENT C3 SOLID WASTS FACILITY � <br /> OTHER CLEANUP SITE(NON-LDP) O FOOD FACILITY C SOLID WASTE VEHICLE <br /> Q UNDERGROUND TANK(MONITORINGIREMOVAL) O Dol:KENNEL 0 PKG TREATMENT PLANT. <br /> Q HAZARDOUS WA511 GEciFAATOR G CHICKEN RANCH <br /> ❑ TIERED PERMITTED FACILITY G MOTELIKOTEL r2 PUMPER TRIICKIIN1 TOILERS <br /> C3TATTOOIBODY PEIRCING ❑ POOLJ9PA Q LAND 115E APPLICATION <br /> .siTE5 <br /> ❑ MEOtCAL WASTE FACILRY ID PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file typo MUST be selected. Fax to 209 464-0138 or mail to the <br /> address indicated above. <br /> 2. END will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appolntments should be scheduled <br /> accordingly. <br /> S. A file that is actively being worked an by 6KD staff may not be immediately availabIQ for review. A new <br /> application may be submitted when the file Is available. <br /> 4. Any fila not returned In the same tonditlon at released will be reorganized by I=HD Staff <br /> at the expense <br /> of the applicant. future file reviews by the same applicant may require a$89.00 deposit prior to revlew. <br /> 8. •TgNTATIVZ appointment dates Must be confirmed with EHD staff. <br /> 6. Applications received after 3:90 pm will be processed the next business day. <br /> r <br /> CONFIRMED-APPOINTMENT DATI? TIME <br /> DATE CONFIRMED PHONE FAX INITLALS <br /> F <br /> REVIEWED YES NO <br /> REVIEW DATE <br /> w ml <br /> ._- ZOIEO'd 812TOV9V60ZT 01 ad 9z:t[ Z00Z til d3S <br />