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SAN JI` 'JUIN GI] UNTYPl1BLIC HEALTH c ^ 2VDGES <br /> d AVIRONMENTAL HEALTH D(VISIL /PU� <br /> 304 EAST WEBER AVENUE, THIRD FLOOR VV�� <br /> vt STOCKTON CA 95202 <br /> (208) 468420 <br /> PUBLIC RECORDS R.ELEA�SJEAPPLJIICAT1 <br /> APPLICANTJ <br /> nn � S BUSINESS/AGENCY <br /> ADDRESS " 7 / W- ) R/I / - L. <br /> PHONE JIA -I/,,/h / � �QtVd FACSIMILE <br /> TENTATIVE" APPOINTMENT DATE <br /> / , t1I TIME <br /> (I give 7 to 10 eusln ^s days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUES noFr - REQUEST ROC SSEfI SN 3 aD51NE5S DAYS <br /> SIGNATURE OF APPLICANT � DATE <br /> ADDRESS <br /> n � <br /> 92015 <br /> rr rr M aJ •s�� <br /> C7�t�'7YJ <br /> , ( , <br /> Ifr r t , "Jt� ' 3Sd rv(�' - <br /> / e - <br /> ENVIRONMENTAL HEALTH DIVISION FILES 'V, <br /> UNDERGROUND TANK JUST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FAcmry f (R J/ . + <br /> OTHER CLEANUP 51TE (NON-LOP) CI FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNu8RGROUNO TANK (MONITORING/REMOVAL) ' ❑. DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH IIIPKG TREATMENT PLANT <br /> IIITIEREDPERMITTEDFACILFY C] MOTEUHOTEL El PUMPER TRUCK/YARWCHEM TOILETS <br /> ❑ TATTOMODY PEIRCING Cl POOL/SPA ❑ (AND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM P 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 type MUST be selected- Fax to (209) 464-0138 or mall 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 rive 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 /> accor4ingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new <br /> application may be Submitted when the Tile 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 /> 5. 'TENTATIVE appointment dates must be confirmed with END staff. <br /> 6 Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS _ - <br /> REVIEWED YES NO REVIEW DATE <br /> -ff Ua 14 nladNu <br />