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„,'I's <br /> FRO, GES <br /> Ins, <br /> km lum COUNTYFUI00 H�� <br /> VI - LTH <br /> F -yAL JilEALIH 131VIS1014 <br /> _NVjR0gMpN <br /> 304 VST WESER AVVNUE'TViIR0 FLOOR <br /> STOCKTON CA 95202 <br /> 001 (209)466-3420 5 APPLICATION <br /> iii-'LALIH FIU13L1CRF-00RDSRF- <br /> 7,'Z- <br /> S <br /> ADD LP L04 7- 00 FACSIMILE <br /> PHONE I <br /> Zi -401 nj�s <br /> jtatlavl <br /> ENTATiVF-*APP( -f <br /> )jNTMf!NTDA1V- ay�kmillio X111 <br /> SIMda"tapp <br /> FEE-REQ VpROPASSED IN Z BUSMgSS DAYS <br /> D <br /> YF <br /> C.IASr A'V <br /> , fSOX To tXFrD11F <br /> RE OF APPLICANT <br /> USE ONLY <br /> 014 Y <br /> —74isii'OF FA�1�-F USSEA <br /> F R <br /> PROG F ONLY <br /> :t <br /> LT-ADDRESS <br /> 0 <br /> / X <br /> NJ <br /> tai Zq-(1 0 <br /> S 3 <br /> ENVIRONMENTAL HEALTH ,nnSjoN FILES <br /> �) Ll HOUSING C3 sOLIELAFI(STE FACILITY <br /> (LOP) c3 50L!DWASTE VHH1CMQB <br /> % C3 FOOD rAq[Ury 13 DAIRY <br /> xeuuoii ROUND TA”(UST)CLEANUP SIT9 <br /> is OTH99 CLEANUP SITE((tMC'NH-r'-00PR) In Doe KENNEL rn pyo TRFATMIRT PLAMT <br /> lt� UNDEI�eWUNDTANK INGfRDIOVAL) RANCH CHJCKI'N HCH 0 puMpErt 7RIJCK'YARIXU4E1 TOLETS <br /> I HAZ us WA.2111 GEN5RATOR CI MOTEUKOTEL C] LANDLD USEAF?LICAIttoli SITES <br /> 9 79KE FLERMITTFDFACIUTY 0 P()OLISPA o ovER iFLEMS SPECIFY ABOVF) <br /> 0 TATT 80DY FEIRCING Cl PUBLIC WATER SYSTEM <br /> 0 MEDIC WASTE FACIIXTY -by checking <br /> vp <br /> Select the type(, <br /> ')of file!;torn the list above <br /> List UP to tan addresser.In the%Pace abo e setacted. F:i!X to( D) 0938 r mai t3A <br /> the appropriate box( )• <br /> AtIaa5tonAfll0tYPQUU$T,' <br /> �i� 2W will be confirmed <br /> jg&lLess in L ave. any EHD files eXist An Ippointment for review <br /> Of application, The files <br /> 2. EHD will notifYthO a0llcantlf but no later than ten(10)days after receipt should be scheduled <br /> appro3xlrnate[y five bijlinasS days o <br /> Is days for review, Appol"Unentr <br /> will be held for ZL MaXIMUm of five JUSInar <br /> by <br /> accordingly. <br /> 3. ay not be Immediately available for review. A nP* <br /> s actNely being W01-ked Or, aiD staff M <br /> A file that I then the fila is available. by p <br /> application may be submitted A be reorganized HD staff at the CXPOnSO <br /> 4, Any 1112 not returned in the same CondMan as released will <br /> of the applicant Future fl[e reviews by the Warne applicant may require a$18.00 deposit prior to Mvi8w- <br /> 5 'TENTATIVE appointment dates must be confirmed with EHI) staff. <br /> '00 pm Will be processed y. <br /> the next business da <br /> 6. ApPlicatiOns received after 3 <br /> CONFIrIMED APPOINTMENT DATE <br /> I <br /> DATE <br /> INITIALS PHONE FAX INITIALS <br /> C <br /> REVIEWED YES NO REVIEW RATE <br /> 014 TOTPL P-02 <br />