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N J, DUIN COUNTYPUBLIC HEALTH S VICES J� <br /> ( � ENVIRONMENTAL HEALTH DIV �"' <br /> Ill 344 EAST WEI3ERAVENUE,THIRD FLOOR <br /> Vim• STOCKTON CA 95202 <br /> PUBLIC RECOR (209)466342/0 <br /> DS RELEASE A)PPIPL(^ICJA/ T6 <br /> IiQ H <br /> APPLICANTDS <br /> LLaY <br /> ADDRESS 23 / ) R60J. S VCCtV1✓ A G [ s2 <br /> 15 <br /> PHONE <br /> FACSIMtLE <br /> TENTATIVE`APPOINTMENT DATE // QAiO/ TIME YCJ _ <br /> (Please give 7 to 11/O, <br /> N <br /> / usin ist days from date <br /> 'Of/2PP11cat1On SubmitteSubmittal)CHECK DOX TO EXPEOIYS 78.00 FEE-RERSS <br /> E REQUEgUEST ED fN 3 8US{NESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS-rorO <br /> n <br /> rt rr r . ,2314,Q301LLIs 9 o -23 6 <br /> u _ . <br /> Xo 8/ l <br /> n 1111111 1: <br /> '2 9090 <br /> r. ., r • r. <br /> 212417 It r r f. it (0/6 a3 ,7. '3 <br /> /n e/ It <br /> / e e23o! r ?.0 6/, d 0 O b o g G2 2rA/`aZ/�op +J/ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(U5T)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLD WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLD WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑. 000 KENNEL ❑ DAIRY J <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARWCHEM TOILETS <br /> ❑ TATTOOIeODY PEIRCING ❑ POOIJSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 4 OTHER(PLEASE SPECIFY ABOVE) <br /> I. List up to tan 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 12091 464-0138 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 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 /> accordingly. <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 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 /> 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 /> EN 94 14 PUSAMB <br />