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SECOR PAGE 01/0 <br /> 07/09/2004 10:09 916860 PAGE 02 <br /> EN\IIF.GNf cNTFL HE H rr1ULVI+NwntK <br /> .. 07/08/2004 13:44 46a01' <br /> �D 11 ������ SANSOAQ� COUNTY ^ DO <br /> ` ENVMONITAJ HEALTuDEPARTMENT <br /> 2504 304 E Weber Ave 3 Floor° Stockton,s95205 <br /> anAjaquin,ca.us/ehd 1 V'1 <br /> Jul- o s (2091468-3420 Fax: (209)464-0138 Web: www. o <br /> ENVIP,ONPAENT N A H <br /> PERfd11TISERVICES PUBLIC �tBCQ�DS RELEASE �SF1'LTCAxZQN <br /> BUSINESSIAGENCY: <br /> APPLICANT: CC ) <br /> ADDRESS- a� <br /> CL <br /> XFACSIMILE: <br /> PHONE: �I7 �) O,I L /-� <br /> Y Tme:� ) 'f — <br /> TENTATIVE"APPOINTMENT DATE: Iicatlon sWmittalj <br /> teley�a allow 10 business days from date of 20P <br /> CHEGK BOX TO EXPEDITE REQUEST-SSS.00 FEE—REQUEST PROCESSED IN 3OBUSINESS DAYS <br /> DATE <br /> SIONATURF OF APPLI"T a f 1 DepartPentUse Only <br /> 4F�" S <br /> ADDRESS <br /> / W5#a �r <br /> ��`� ✓ ao E <br /> a. met45. reel G a. Sim <br /> N, St,"t OS. Sim- <br /> e ��t <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> [2 HOUSING ABATEMENT ❑ SOL1O WASTE FACILITY <br /> I UNDERGROUNO TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY O D°� YwPSTEYGHICLE <br /> OTHER CLEANUP SrM(NON•LOP) ❑ DOC KENNEL ❑ PKG TREATMENT PLANT <br /> ONITORINGRtEMO�AL) ❑ CHICKEN RANCH p PUMPER TRUCKIYAROIOHEM 701I.ETS <br /> ?D UNDERGROUNDSTE E ❑ MOTEUHOTEL <br /> MAZARpOUS WASTE GENERATOR ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> TIERED PERMITTED FA13LITY ❑ pTHER(PLEASE SPECIFY) <br /> d TATToo1BODY PIERCING s by checking <br /> n MEDICAL WASTE FACILITY e s of files from the HsA'I38yor mail to th <br /> to ten addresses in the space above, Select the typ ( ) to 2Q9 4 <br /> f. List up At least one file type MUST be selected. <br /> the appropriate box(es1• <br /> address In icated above, EHD tiles exist M appointment for review wIU be confirmedTe files <br /> EHP will notify the applicant if any da after receipt of application.lon. <br /> 2. approzimatetyfive business days but no latern ten(10} Ys olntmonts should he scheduled <br /> will be held for a maximum of five business d for revia^'b�mmediately available for review. A new <br /> accordin8lY• worked on by EHD staff may <br /> A fila that is actively being EHD staff at the eXper!5e <br /> a oSit prior to review <br /> application may be submitted when the file is availah e• uire a 593.00 dap <br /> 4 same Ircant may req <br /> Any file not returned in the same condklon as released will be reorganized y <br /> of the appitoant. Future file revlewustbeheonfifinedwith EHD staff. <br /> 5. <br /> 'TENTATIVE appointment dates m will ba processed tha next business day. <br /> B• APpncatfons received after 3:0 p . . . <br /> TIME <br /> CONFIRMED APPOINTMENT DATE PHONE FAX INITIALS' <br /> DATE CONFIRMED NO REVIEW DATE <br /> HEVIEW£D YES <br /> END dMI wa <br /> yNaeaa <br />