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12:34 FAX 925 945 6485 WES'LCL^�;:;r;;NUT CREEK <br /> 07/22/fnnz - o;nn 4ii4U13� <br /> n r•'�""' I402/002ENVIR0I4NTAL �TH PAGE <br /> 01 <br /> i NO AQUIN COUNTYPUSLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION ] �� <br /> 304 EAST WEBER AVENUE,THIRD FLOOR t' <br /> STOCKTON CA 95202 <br /> RDS g <br /> )468-3420 <br /> `: 4USUC RECORELEASE APDL►CATION vp;',3 � X�-3 <br /> APPLICANT I L_P_ v>1 BU`SR"41ESSIAGENICY W2S�0✓1 <�;jnjtj <br /> /Ll0✓ISI ,(�C <br /> ADDRESS j �1 vd. v V a 11'�J S' ML•.G 1�}_.._�� -1 s.Cl 4 <br /> PHONE 2-r7 -C3-7 Cj .-�-1 rJ(p S <br /> �----- - FACSIMILE <br /> TENTATIVE'APJROINTMENT DATE -7j -31)102- TIME 10; 004 A <br /> (Ple�a�se-L[Pw T to 1a bualnass�fp3date ofTQa�WIcaHon auhmiUal) <br /> CHECK BOX 7o IXPEDHT-REQU/ES7T-�� OUESTPROCES 41 3131USINESS DAYS <br /> SIGNATURE OF APPLICANT "z� C DATE ?: <br /> PILE ADDRESS THIS SIDE END STAFF USI: <br /> PROGRAM ELEMENTS S i <br /> Q <br /> erlk <br /> 1A 14 51 PSI, Sn A <br /> w�o n kO n <br /> J o <br /> 0 t MI vc_ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> q UNDERGROUND TANK(U911 CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY - <br /> 1� OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHK:LF'�". - <br /> UNDERGROUND TANK(MONITORItN01REMOVAL) ❑ DOG KENNEL ' ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PL <br /> TIERED PERMITTED FACILITY ❑ MOTF_LfNOTEL ❑ PUMPER TRUCK/YARL*AEM TOILETS <br /> ❑ TATTOOISODY PEIRCINO ❑ POOLISPA O LAND USE APPLICAAW SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ton addresses in the space above, Select the type(s) of files from the list abA)v by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138*mall to the <br /> Address indicated above. I ".` <br /> ( <br /> 2. EHD will notify the applicant if any EHD files exist, An appointment for review will be cdormed <br /> approximately five business days but no later than ten (10) days after receipt of appl16N''n. The files <br /> will he held for a maximum of five business days for review. Appointments should be s3)heduled <br /> accordingly. r' <br /> 3, A file that Is actively being worked on by EHD staff may not be immediately available fgfroview. Anew <br /> application mail be submitted.when the file Is available. i <br /> 4. Any file not returned In the same condition as releasad will be reorganized by END sla50at the expense <br /> of the applicant, Future file reviews by the same applicant may require a$69.00 depogR'prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> .6, Applications received after 3:00 pm will be processed the next business day. <br /> I <br /> CONFIRMED APPOINTMENT DATE. TIME 1'>i <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />