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i33/21/20�2 08:33 2094 8 AGE STOCK70N PAGE 01101 <br />�. ,".L .`.. EItO LOG NUMBPR <br />SA AQUIN COUNrr <br />. ENVIRONMENTAL HEALTH dIVISrQN <br />344 EAST WEBER AVENUE, THIRD FLOOR <br />HE A1_ y 1 STOCKTON CA 95202 ylo!g <br />I, , 208 468-3420 <br />S RELEAC= APPLICATWI <br />APDL &V <br />ADDRESS <br />PHONE <br />PUDLIC RECORD <br />BUSINESSIAGENCY <br />7-10,06 11,06 FACSIMILE �' ' ' <br />TENTATIVE' APPOINTMENT DATE <br />(Please give 7 <br />13 CHECK BOX TO EXPEDITE <br />submittal) <br />DAYS <br />SIGNATURE OF APPLICANT <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />DATE /6—R-0-, <br />- <br />I <br />UNDERGROUND TANK (U$T) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />OTHER CLEANUP 517E (NON -LOP) ❑ FOOD FACILITY 4 SOLID WASTE VEHICLE %A <br />UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ 006 KENNEL E1 DAIRY <br />HAZARDOUS WASTE GENERATOR 1:1 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />TIERED PERMITTED FACILITY M MOTELMOTEL 0 PUMPER TRUCKIYARDICHEM,TOILETS <br />❑ TATTOOIBODY PEIRCING ❑ POOLISPA 0 LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 0 OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ten addresses in the space above. Select the type(s) of fifes from the fist above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (2091.464-013a or m o 9 <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 fifes <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 EMD 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 EMD staff. <br />6. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />TIME <br />PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />FN CO 14 0AM.W94 <br />