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«�P. l. ZVVO |0 <br /> . '. | |8M No. 9539 P. 1/2 <br /> DATE RECEIVED <br /> cnnmawomm� <br /> - �`|`' ` ' ' `-- ��/�� 0C�����[Ji�� ����U��TY <br /> ��)�� / ,/�=i/^ ^'^,!i � ~~~ ~" — ~� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ^ SOO Fast Main Street, Stockton, ` `95202'*029 <br /> Telephone: (209)4�8'�4�O � A)484'- <br /> � <br /> — --- --' ��~^ ~ ~' � C)8P'����K U�� RECORDSU�U�U EA��U� ����Uo�_���TU <br /> ADDRESS; 1600 AIWO-rA Aw_ skive- mwetl)� City/State/Zip <br /> PHONE(1): 6 VS)138-&0 x0 PHONE(2): FACSIMILr--, <br /> TENTATIVE*APPOINTMENT DATE: Time: 4`4"1 <br /> (Please allow 10 business days from datd.of applicaftlon submittal-'Tentative only-must be confirmed) <br /> O CHECK mDxToEXPEDITE REQUEST $11CHECK ONLY) nsAVe$rPROCESSED/w3BUSINESS omyw <br /> SIGNATURE DFAPPLICANT �Z log <br /> ' <br /> Electronic Informat <br /> Street 0 ID USE ONLY <br /> -17 <br /> 4. UnIt3 <br /> L3 unit 5- <br /> Unit 6 <br /> 10. <br /> Specific Date Range of <br /> tUNDERGROUND TANK(US— tACILITYNEHICLE <br /> OTHER CLEANUP SITE(N( <br /> NDERGROUND TANK(M <br /> E3 MEDICAL WAsTrz FACILITY <br /> WEuAwomc�— -------�---- ------�---------------- <br /> _—_-------�—'— Xvmmoxouo^`o. <br /> 1. List uptvton oddm, __--_- eNngthmmpprwpd�e � <br /> bmx�w) �u�m*���� --'---------�---�--'� -------'----'--------' <br /> ' ---- dicated above. nmws <br /> ranges will not beuc plications receivedwhter <br /> 3:OOpnwill hmp,uc,_____________�____—___ --'�_-__ _----------�--�--� <br /> 2, The EMQwill notify t ned pN <br /> | uy approximately <br /> "�x°°"°"��"° w�. Appointments <br /> should bom�hodu|�o---------'----'—'--- <br /> %. Afile that|wactively Anow application may h* <br /> submitted when the <br /> `-------''------------'----- - <br /> 4. Any flie not returned In the same condition as released will be reorganized by EHD staff xuthe expense pYthe applicant. <br /> Future file reviews bythe Same applicant may require w*1O5 deposit prior hxreview. <br /> EHDUSE ONLY <br />