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SQA,- ,J UIN COUNTYPU LIC HEALTH S 'VICE <br /> VIRONME TAL HEALTH DIVISI <br /> S14 RU <br /> 304 EAST WEBER AVENUE,THIRD FLOOR -Ff- <br /> STOCKTON CA 95202 <br /> (208)4683420 <br /> PUBLIC RECORDS REL SEAPPLICATION. /}rte,y� � ��/ <br /> APPLICANT BUSINESSIA+GENCY [.r l)—ija'}ce Ll"tQ U/Ir'�L�a.6tLeA &4 tx. <br /> ADDRESS Ll Q /U. 0 ho/) O)aLf EZnCeb419 J� ..1 rR/�(:��— <br /> PHONE d FACSIMILE <br /> TENTATIVE'*APPOINTMENT DATE � TIME / r z � <br /> (Please gave 7 tv 10 b sines day8 frpm date of application submittal) m� O© <br /> CHECK BOX TO EXPEDITE REQU T-$78.00 FEE-REQ UE T R4 ESSED IN 3 BUSINESS DAYS � T o <br /> SIGNATURE OF APPLICANT DATE <br /> n , FILE ADDRESS <br /> CA <br /> 012 7,Z7 <br /> i' E 3 <br /> ? - <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A13ATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLIn WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGJREMOVAQ ❑ DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> L3 TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ID TATi'OOIBODY PEIRCING Q POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTIrMOTHER tPLEASE SPECIFY A80tyt <br /> lLCa $ `11X. <br /> 1. List up to ten addresses In the apace above. Select the typ (s)of files from the Ilsbove by checking <br /> the appropriate boX(es). At least one file type MUST be selected. Fax to(209)ati4-D138 or mail to the <br /> address indicated above. <br /> 2. EHD 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. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by END staff may not be immediately available for review. A new <br /> application may be submitted when the file Is available. <br /> 4, Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$78.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 putt will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWER YES NO REVIEW DATE <br /> Eh 00 1aviRWO <br />