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10/02/02 WED 15:58 FAX 19168582355 SHAW E & I 0 002 <br /> 09/11/2002 14:36 4640138 ENVIRONME-1•ITAL HEALI" rAtIL cl <br /> -� SAN�ftgQUIN COUNTYPUBLIC P.111ALTH Sk-04VICES _ <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,MI RD FLOOR � <br /> STOCKTON CA 9520:! <br /> - , TIE l: (209)46e-3420 ,�•�q -if C,V -O Qib 0 3 2002 <br /> ' PUBLIC RECORDS RELEASE. APPLICATION <br /> ' }' r�yl tIEALTH <br /> PLICANT^ h dUSIFIMSIAGENCY Z&:x� FK J 1��t+��� <br /> ADDRESS, OO 5-F'e1-4- C��C�a � a� <br /> PHONE `?Zj---2 8c4- 23 Y FACSIMILE``$Z S-+1�1Z�-- zai <br /> •TENTATIVE'.APPOINT eNT DATE /D 7 -O Z <br /> (Please ve to 10 byslneas fro 01'alp Ica iNon subntl )J ' <br /> CNECK BOX TO EXP_DITE REgUE5T• 00 FEE <br /> RNEQUEST P D�' USINESS DAYS LU <br /> SIGNATURE OF APPLICANT _ DANE: /D -- Z -,D _ <br /> 77 <br /> r, <br /> FILE AO RE39 - D ST�tI • <br /> THIS SIDE EHFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> LeaL <br /> ENVIRONMENTAL HEALTH DIVL S ION FILETS <br /> UNDERGROUND TANK I UST)CLEANUP SITS(Loop) G HOUSING ABAT6IME:NT O SOLID WASTE;FACILITY <br /> 10 OTHER CLEANUP SITE iNON-LOP) O FOOb FACILITY O SOLID WASTEi VENK:LH <br /> DO UNDERGROUNo TANK IMONITORIN6/REMOVAL) O DOG KENNEL O DAIRY <br /> O HUMI)OUS WASTE GI INERATOR b CHICKEN RANCH 13 PKG TREATMENT PLANT - <br /> O I ERED PERIi n-mo PAI;ILITY G MOTHLIMOTEL 13 PUIMP9R TRUCK/YARDICHEM TOIj_ETS - <br /> O TATTMA900Y PEIRCIN G O POOLJSPA O LAND USE APPLICATION BrITS <br /> O MEDICAL WASTE FACILrrYO PUBLIC WATER SYSTEIM Q OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ter addresser in'the space above. Select the typm(s)of flies from the list above by checking <br /> the approptiltte bex(es);' At least one file type MUST be sekicted. Fax to(20914,64!.0138 464139 or mail to the <br /> address indii:ated aba;VC <br /> 2. END will notify the applicant if any EHD flies axist. An appa Itttment for review will be confirmed <br /> approximately five busMoss days but no later than ten(10) days after receipt of;Ipplication. The files <br /> will be held f)t'a maxirrtlim of five business days for roviety, Appointments ShOLIld be scheduled <br /> accordingly. <br /> 3. A file that Is;Ictively bdlilg Worked on by EHD staff may not be immediately available for review. A new <br /> application may be sulttltted when the file is available. <br /> 4. Any file not rstumed its the same condition as released will I)e reorganized by END staff at the expense <br /> of the applic:Int. Futut}e file reviews by the same applicant tray require a $89.00 deposit prior to review. <br /> 5. 'TENTATIVE: appolnuftnt dates must be Confirfned with OJI)staff. <br /> d. Applications received after 3:00 pm will be processed the iiext business day. <br /> CONFIRMED APPOINTMENT DATE, �. •ri MI± <br /> DATE CONFIRMED _ PHONE FAX ,INIVALS <br /> REVIEWED YES NO RSVIEtN bATE <br /> nl mr <br /> • 09/11/32 WED 13:33 [TD:/RX NO 76961 IM001 <br />