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EN <br />6IN COUNTYPUI3LiC HEALTH SE ES <br />ENYIRQNMENiAi.14EALTN DIVISION <br />WWI <br />APR 0 7 2003 � EAST wF-IaER AvzNuic, THIRD FLOOR <br />STOCKTON CA 95202 <br />VIRONMEnrr uc (209) 4WS420 I CK%30 <br />Ulf 5 <br />TENTATIVE' APPOINTidENT DATE 45 seen a S c8os4ed IC TIME <br />(Pita®* ViVO T to 40 burIn®a�om data of Applicadon subm l) <br />u CHICK t3OX TCe E%MtT1; REQUEST -=89.00 FEE- REQUESTPROCESSED IN 3 UL SWE33 DAYS ®� �� >S'eyV .► S �G/R j�/Cz(/�s4 <br />''SiGNATURE 01- APPLICANT ��UI - -- DATE ► % �''' 7��i001 <br />Mo., dwAf <br />�+�•--- •••. S SID $FI NL <br />t PIA ADDRESS PROORMI E__ SE CH <br />M <br />ENVIRONMENTAL FlEALYH DIVISION FILES <br />O UrtDERGROUND TANK (UST) CLEANUP SM E (LOP) O HOUSING ABATEMENT t7 OQUD WASTE FACILITY <br />C3 FOOD FACILITY t7 SOLID WASTE VEHICLE <br />0 OTHER CLEANUF SrTE (NON-LCP) 0 DAIRY <br />0 UNDERGROUND TANK CMONITTCRINGIREMOVAL) 0 DOG KI;NNEL ❑ pKG TREATMENT PLANT <br />❑ CHICKEN RANCH <br />O HAZA?tDOU9 VIAS iE GETJi�-FTAT'7R n pUMPER TRUCK/YARDiCHEN TOILETS <br />TEL <br />0 TIERED PERMrrT%p FACILITY O LAND LJBE APPUCATION SITES <br />❑ � LISPA <br />❑ TATTOOiBODY PBIRCING a O OTHER (PLEASE SPECIFY ASOVE) <br />. <br />la MEDICAL WASTES i=ACIL)TY <br />List tip to ten addr(.$$4% in the space above. $elect the too(s) of tiles from the list 13Qv rbmal to theg <br />1. <br />the appropriate, kw)'(es). At least one file type MUST be selected. F <br />addre►sE'r Ica �� <br />2 Ei�tl7 wiG notify the Applicant if any EHD tiles exist. An appointment for review will be confirmed <br />later than tan (10) days after receipt of 2ppilc2tion. The files <br />approximately fire business days but no <br />five business days for review. Appointments should be scheduled <br />will be geld for ai rf9:aximum of <br />accordingly. <br />is actively being worked on by EHD staff may not be immediately avallsble for review. Anew <br />3. A file that <br />applicaltion may be submitted when the file i$ available. reorganized b fiHD aleft at the expanse . <br />ra ned in the same Condition as rc will be reorg y <br />$89.00 deposit prior to revi►w. <br />q. Any fila not <br />appli <br />the Futuro file reviews by the same applicant may require a <br />of applicant. <br />dates must be confirmed with EHl7 atm <br />5. =TENTATIVE sp*ntment <br />after 5.00 pm will be processed the next business day. <br />6. Appliaations rgt:eivsd <br />TIME <br />CONFIRMED AP TIME. <br />i <br />I <br />PHONE FAX iNLTtALS <br />DATE CONFiR.UIP .�...,._ <br />nn D Y-E:s NO r�,nE W vA <br />Ed WUSO:OT :=01� 40 '�dy <br />[�9?.F.t:�l <br />