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i;il 7 E IREGEIVE <br /> 1111 L��I 11 V L� RNVIRONIi'.tENX'A.L REALTH DEPARTMENT � <br /> 304 E Kober Ave P Floor Stockton, CA p,3205 <br /> SFP t g( '� 46 -3420 Fsx., (209) 46401.38 Web: w!�r,co.sar�joayui.n.Ga.us/olid <br /> ENVIRONMENT HEALTH ' �`:BLXCX CORDS ULEASL PLICA,'T'TOIA1111i <br /> RUSINESSIAGENCY, <br /> F+HOME: _� �*�' - — FACSIMILE: _ -�C�'' w <br /> 7F–NTATiVE'r,E§?GiN,'MENT DATE: 1� 7r���P ;Mme;-21_�_ �- <br /> (Fiease atlom 10 business day,from date of a <br /> TO QLD <br /> �1-IEs�1TCx-,D E?CP�L:t�l'c r�in41+!EuT-s93.Ofl FES-REQUEST PROCTwSScD i s <br /> H.IONI�TFRI �= �'Ll �,i�T SEP 2 2 0 _111 <br /> DGnar'�nerni Use OHY <br /> ADDRESS UNIT <br /> Uni'~ 1 <br /> city <br /> opo Unit I <br /> c1t. <br /> Ctrrr,: ...CityUnit 4 <br /> _— `l � �._ G — unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMF_L7NT FILES � <br /> UNDER.G'�OUND TANK!USIJ CLPANUF$IT:E(LOP) V HOUSING AeATEM€NT G SOLID WASTE FACILITY <br /> ' <br /> OTHER rtC'��4iIJ�SITS.!JgOK Lrjr) 0 FOOD FACILITY 11 SOLID WASTE VEHICL,F <br /> J ifN11))Fp-ay OUKnTjVK,fAONI'TORING/REMOVAL) © Doe KENNEL ❑ DAJRY <br /> I1 Hk�?A=;I9o>;E9 WASTE GC-NFPATCIR 13 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ER, D PEF.Mil-rED FACILITY �M®TELIHOTI_L 0 PUMPERTt�,t�s.l<!'f?R.F <br /> '� <br /> ❑ "'AaT=SODY FJIERCI(4G ❑ POOLISPA ❑ LAND UISE APPLICATION SETES <br /> C MEDICAL WASTE FACILITY ❑ OTHER(PLEA$E SPECIFY) --_MOO <br /> List up to te:1 addresses in the space above. Select:the type(s) of riles from the list above by cher icing f/� <br /> ;1�e pprtipl l ige box{es). At least one file type MUST be select-ed. ax tar[ ,() �4�Di38 or Maila�l' a %F1 <br /> Adei� s iiat��l abwy , <br /> �. 1 i v=Ziff nctify the FV,;11ic8nt if ani°EHD files exist. An appoTritment for revile w;net°Ek�<< e..n. nf1 ins <br /> approximately five business days but no Eater than ten(10) bays after receipt of applirativin. Thr file-15 <br /> will he ha'r,d for a maximum of five business days for review. Appointments should be schedvied <br /> asG�f'clli1�ly. <br /> A Mv that is a(.Uvely being work9d on by EHD staff may not be immediately available for reg.sieve. A ne-w <br /> .p<<satcr� -n,12,Y he submitted when the file is available. <br /> {. Arr,r VIP nit returl',e,l in the same condition as released will b refar�ani:�e�l by�i-11� staff at t#ie �xlaense <br /> cif ti e appIicant. Future file reviews by the same applicant may require a 6393.00 dreposia +riot L� <br /> ITENTATIVE appointment dates must be confirmeea with EHD staff. <br /> Applications raueiverl after 3:00 pm will be processed the next business day. <br /> F�l=CIRT11t4ENT ,ATE _._ _.�----- �� TIME <br /> DATE C;;;t�?�='a:.r Els � . � PHONE <br /> FAX lPil!;AP_3 <br /> REVIEWED YES NO REViFW DATE <br /> ertu es-v�w�'s <br /> i§?Sl�6G3 . <br />