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[ 209;532 P}?�3 >P 01@ <br /> aGT .13-20 �HD.LbG NOW <br /> �A`i'ERECEr11tE:D • �� . ,�jANi�QA.QTIII�I�OX . <br /> ENV]XtO�N';�AL��'I'g T1EP LTFi�NT <br /> T 2004 304 F,Weber Ave 3 door Stockton, CA.95205 <br /> OC.. 1 2 67Z <br /> {209)468•-3424 Fax: (209) 464-0138 Web:ww. -CO. jaaquiax.Ca.us/ehd <br /> ;.,��=1�� 3�; pELEASE Az'PLICATION <br /> P P7Nj {- RVICES PUBLIC RECORDS <br /> APPLICANT- euslNE=AGENCY:_ �� <br /> AnaRESS: Nn _El ZF <br /> If PHoN> x FACSIMILE:, <br /> • S '3b <br /> TENTATIVE"AppoINflNEW DATE- Tame: <br /> (PhMS'A allay 10 pUeiness dartrom 0go of apPIlcmU <br /> nn sutm,it Q <br /> 4 <br /> I ❑ CHECK gOx To ExpEDI =REQUEST-$"-0()FEE-REQUEST PROCMM IN 3$USWlC55 DAYS <br /> DATE — <br /> SIGNATURE OF APPL.1GANl` Dwartrmnt Use Ondr <br /> UNTT <br /> RLS ADDRMv - <br /> E L ATHI qr, <br /> Unitz sane Unit 2 <br /> �. sr ODb• _: Unit a <br /> a. shim �' �:. -M� ' r : <br /> Unit 4 <br /> 7. s ~� <br /> e. a ❑ Un}t 5 <br /> 1a � • <br /> ENVIRONMENTAL HEAL-TH DEPARTMENT FILES <br /> 16- <br /> uNDEr GaoUrta TANK(usT)CLEANUP SITE(LOP) E3HOUSINGAaAItMEln' soLila wAsrE ILTY <br /> C3 FOOD FACTY �SC M WAS"M VV"CLE <br /> IIJ <br /> OTHM CI• mUP SrM(NO"OP) Doe DAIRY <br /> UNDERGROUND TANK{1I 0WORINGfRE llt]YAL) Q C�NNR NCH p PKG 11"TMENT PLANT <br /> HAXARDous wAsTE GExr;RATDR Ca MOTE1_1HDTEL 0 PUMPER TMICKMAROMEM TOIkS-M <br /> Pr TtFRFD PFRMI I I FACII ITY E1 POOLAPA LAND USE APPLICArON SM <br /> ❑ TA1700l 0130 PIERCING Q OTHER(PLEASE SPECIFY} <br /> iMIEDICAL WASTE FACILITY <br /> 1 type($)of files from tris list aboye,by checidni <br /> q. List up to ten addresses In the spade above. Select the typ t ) <br /> the appropriate box(es). At Least one file type MUST be selected. to 2p9 etfi4-O�t3s ar r►�all to the <br /> address indicated above,x. EHD will notify the applicant if any EHD files exist. An appointment for review will 6e confirmed <br /> approximately flue business um#five bu mess daysrerevlevv. �poir�trnentsaftr ;sho of Pd be schn.eduled <br /> edfiles <br /> will he held for a maxim <br /> accordingly. <br /> 3. A file that is'actively being worked an by EHD staff may not be immediately availab for re new. A net <br /> application may be submitted when the file is available <br /> �4. Any file not returned the <br /> v ews by the same applicant may require a$93.00 d will be morganized depo it prior tom seg <br />+ of the applicant. Future <br /> e. ''i'EN7ATIVE appaintrnent dates must be confirmed with EHD 5�ff- <br /> 6. Applications mceived after 3:00 pm wilt be processed the next business day. <br /> CONFIRMED APPOINTMENT DATir TIME <br /> pHp E . FAX INITIALS•'r_.--- <br /> BATE CONFIRMED ; <br /> REVIEWED VES NO REVIEW DATE TOTAL P.O: <br />