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FF'LIP 1 `=Q-P F,�se Eriw i ranrne��td l I r FH: h•10. 2095590-295 T7.irr. L`4 2UU0 .02:S3PH F'1 <br /> , tµo Luc HUMu�K <br /> �w�.•_ SAID .IOAaU1 l COWNPUBLIC HEALTH SERViC�� <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 344 EAST WEQEzR AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 ��• <br /> (109) 4613.3420 JUIV 9 <br /> PUBLIC RECORDS f2ELEABE APPLICATION 040 j <br /> -�•^u-7c Ar.FSa,-t SUS1h1ESSJ/aGEIfCY ������. �~�y'��~� p`� N ENT yEAi< <br /> APPLJCART <br /> ADDRESS �t3'7 �6+ E 1.137-146 <br /> PHONE <br /> FAC 1I 11LE <br /> •�o Z Y ��'c�"1 <br /> TENTATIVE`APPOINTMENT DATE TIME. <br /> {Please glue 7 to io business days from date of applicatipA submit <br /> © CHECK BOX TO EXPEOITE REQUEST-578_¢O FEE-REQ;UEST PROCESSED IN 3 BUSMESS DAYS <br /> SIGNATURE OF APPLICANT <br /> �w r- L• �.-v- "� DATA cpIl41 C� <br /> h <br /> FILE AODFi1=S5 <br /> �? irias� ,Asir U" "txohD Tfztac,�l Gly $ ��S <br /> L ( 3 a C) <br /> 1 <br /> R .L �1 1 <br /> tt It q <br /> 11 <br /> qo �3 °100 <br /> y <br /> Zia <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> W UNDERGROUND TANA LUST)Ct-EANOP SITE(LOP) O ',HOUSING ABATEMENT 13 SOUP WASYC PACtUTY <br /> OTHER CLEANUP SITE(NON-LOP) 0 Iii0i0b FACILITY 11 SOLO WASTE VEKtCLE <br /> C$ uNDERCROUND TANK tm0NITORINGIRI;MOVAL) 0 DOG:KENNEL ❑ DAIRY <br /> HA7ARDaUS WASTE GENEFATOR R ,CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 9 71ER:p PERAtiTTFD FACILITY M !MOTEUROTEL ❑ PUMFER TRUCK YARDICHEM TOILETS <br /> 0 'TATTOO ERIM300Y PED FACT R POOLISPA n LANE]USEAPPLIGATION SITES <br /> CI 7JSEpIGAL WAS7i FACILITY C3 i PUBLIC WATER SYSTI=hf O OTHER(PLEASE SPECIFY ABOVS) <br /> 1. Exist up to ten addresses ETI the space above. Select the typo(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST":selected, Fax to(2091 46A-a'138 or mail to Viet <br /> address indicated-above. <br /> 2, EHD will notify the applicant if any EHE 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 files <br /> will be held for a maximum of five business days for review. Appointments should be scheduied <br /> accordingly. :3 <br /> 3. A file that is actively being worked on.by F-HD staff may not be immediately available for review. A new <br /> appilcation may be submitted when tha file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by A=HD 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 appointmer<t dates must'-be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm w111 be processed the next lousiness day. <br /> CONFIRMED APPOINTMENT DATE= TIME ... ._..^.-•-- <br /> DATE. CONFIRMED FKONEw FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> E:x oe to a�ros�ac ti <br />