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11/ 2 � ?7 ' 4640138 ENVIRONMENTAL HEALTH PAGE 01 <br /> . L'WROMEMA.L REALTH DE'4'amMENz` <br /> 1 7 �-L� 304 Fast Wtbcr Avraue, 3"F100r, Stockton,CA.95202-2708 <br /> TciephOnu(209)468-34n Fu:(209)464-0138 Web.wwwxjpv.0rg% <br /> ENARCI'Vly?E'UT HEA!T �O <br /> PE[AjjT/SERVICES �UI3LZC WORDS RELEASE A.PPLICAUON <br /> API riT: BUSttd=AGENCY:_ ; IKur1%c;jU,I �ru'ufj�, - <br /> ADD RMS: o 1Alt' d <br /> P1iONC(I PHO (I)-, t=��raaua syo) �-dao7 <br /> TENTATivE`APPOprr>Y atT DATE: <br /> (Pkv Orr 10 N410=da>✓f wn craft or apoQ40n Aibm".•)'«ta6ve <br /> Duty.r��wnflnj�«q . <br /> CIMC K BOX TO OitM RE •;93 00 (GASH ofi M E CK tNtL n-FMUMT MO,=S8r=D IN a aLemms ttA s <br /> `SIGNATURE 4F APPI.tCANT DAZE <br /> UW D(9TR1ptI1MN a Unk *- z Unk ante s a <br /> 00W( <br /> FILE ADDRESS FHD USE ONLY <br /> Wed Uame �y <br /> z k' <br /> 2. Mob 4J <br /> 4. W I ct vy� <br /> 7. <br /> 8. <br /> 9. <br /> 10. <br /> 'Spoeliie para Range of Inform don Requestod:From _ to <br /> EW RONMENTAL Ht=ALTH DEPARTMENT FILES <br /> �1 U tz TAW(Ust)t1 r -"1M(Lor) ❑HOV=4a AZA'rsce a Arsas.a WASTE FA=JrfNb=LE <br /> ?si oncsc Food FACLnY 1161"'M Tse <br /> Ul6 tt04M TAW(1A Qt41 A00"MA14 ©Mi KERNEL P DAIRY <br /> H�a�ar�usw GE ruTaa rJ Ct atat l2uxc( M VIASTMAMTns.NDITPLANT <br /> TSDPSIORTEWFAgCTY ❑NYOtEIJF{4SEl QPe tTftU=1fA eTnRFts <br /> O TA"00(0= ol Pootrw <br /> S L�ZLAW USE AePLCATW Snm <br /> o kcmcAr 1f4TeFACXM Orin a r'�C'w _2n �r�e�3J11 <br /> WELL AM S9 r PaaaT k=FOS ARE AVAILARLE K9 NWPW Y• MOHDAV�AMAY t-00 AM-6;60r1 W HWDAYS- <br /> 1. List up to.ten addresses In the space above. Select the,types)of files from the list above by cheeidng the <br /> atppropriate box(es). At least cme fide type!~MUST ba aolected. Fax to(30SJ 4 of 38 nr mai!to the address <br /> ljojS-a'd aInye- Address ranges wit[not be Accepted—for addittonat assistance wtth file addresses,contact <br /> tt*tEK:L Applications recelved after 3:00 pm will be processed the next businezz day; <br /> :. 7"he FGD will notify the applicant if any EHb files exist An appvtatment for review w1a be confirmed <br /> approximately ten(10)days after recetpt of application. 'rhe files wilt be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. Afile that Is actively being worked on by MM staff may not be immediately avaltable.for review. A new <br /> applioz0on may be submitted when the file is avaY N0- <br /> 4. Any fie not returned In the same condltlon as released will be mrganized by EHD staff at the expeltse of the <br /> applicant„ Future fde hevievvs by the same applicant may require a$33.00 deposit prior to tcvl6w. <br /> w� <br /> C <br /> it z;m <br /> V <br /> TB 39dd GNd-1AV0 OWd LaZ689Z0T9 06:ZT 500Z/LT/TT <br />