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LA <br />I -U. <br />L_iAu l"�ti-j i n.. f'i? is^n i.. _ : a'11 J.. -,..=•..r -�-:ss • _ v,._ <br />1V l�Lh 1,`•i] fJ% P.01 <br />D;i: c iYEGfn.eG <br />; <br />�,N JIN COUNTYPUBLIC HEALTH SER S <br />*tV1R0NMF-NTAL <br />G i 4O LOG t+t 11SAIE° R <br />f-� i- ,'._\�I_. ! '/ L <br />C'' <br />HEALTH DIVISION <br />304 FAST WESER AVENUE, THIRD FLOOR <br />MAJ 1 9 2001 <br />STOCKTON CA 05202 <br />VV <br />NONEM �s <br />(209) 468-3420 <br />V <br />Elm <br />6U31Nr:Z&AGERCY <br />79 <br />FACS13AILE _ CPU- J J 5" 0 f <br />R 20 <br />TZNTATIYE' APPQ1�TMFNT PAT—L TIME <br />'(Pteaac ytYc 7 to 10 business days from dart 01 application submMal) <br />CHECK BOX TO EXPEDITE Ft4C]U 00 FEE — REQUEST ROGESS€D iN 3 BUSINESS DAYS ' <br />SIGNATURIt OF APPLICAN" ` G�.L�-f DATE f - <br />r .. <br />i <br />MF7 0.1'M4, <br />Ell WIN d7 <br />IT <br />1��1[tt�1111'r11�L' <br />NONEM �s <br />1IrAIWAN. <br />ENYIRONMENiAL HEALTH DWI$10N FILES <br />JdU140E9v1%Q UNQ TMK (use r�uP srff (LOP} n Heusi me AEbATU ENT 0 SOL11) WASTE FACILITY <br />?3 OTii£R CLEANUP SITE p90N-L9P) Q 11 SOLID WASTE VEHICLE <br />9.UNDE1RGiROUNDTANKjfdON rORING IREMOYAL) . R DOG KENINEL R 0MRY <br />' <br />HAZARD= YVAST£ GENEKATOR 0 CHICKEK RANCH 0 PKG 7REATMENT PLANT <br />O TIERED P i(TM0 FAC)11TY a MOTELMOTEL 0 PUMPER TRur- WAROICHEM TORATS <br />13 TATTO01500Y PEIRCING a P00USPA ' ' - In LAND us AAP'ucA-00N siTES <br />O MED1CA4 WASTE FACture 0 PUBLIC WATER =TLM 0 OTHER IPl.EASE SPECIFY ABOVE) <br />2qz T-5� <br />T ' <br />1. List up to ten addresses in the spaces: above. Select the types) of files from the list above by checking <br />the appropriate box(es). At least one file type MU4T be selected. F ?S L�42U9146�I b1 mall to the <br />address indicated �6op y- <br />2. END will notify the;appiicant if any ZHO flles exist. An appointment for rlavlew will be confirmed <br />approXimately fivo!business days but nu titer than ten (10) bays after receipt of application. The tiles <br />will be held for a maximum of five business days for rouiew. Appointments should be scheduled <br />accordingly. <br />3- A fife that is actively heirig worker! onlay EHD staff may not be immediately available for review. A new <br />application may b� submitted when the Tia is avaiiabla. <br />4- any rile not returned in the same condition as relaaaed will be reorganized by EHO staff at the expense <br />of the applicant. Fistiwo fits reviews by the same applicant may require a $57.00 deposit prior tv review. <br />5. 'TENTATIVE appolAtment dates must be confirmed +mitis EMD staff. <br />6- Applications recei+ied ,after 3100 pm will be processed the nett business day. <br />CONFIRMED APPOINTMENT DATE TIME. <br />DAISCONFiRMIED PHONE FAX INITIALS <br />R -VI WED YES NO REVIEW DATE <br />TCfTAL P.01 <br />