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07/02/2002 10:28 FAX <br /> .....,a..� �.... .�.,,•�,,,... 1­11 . <br /> aar� aean%00t+uane� <br /> :, },SAN,1C UIN COUNTYPUBLIC HEALTH S ICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> v MW <br /> 304 EAST WEBER AVENUE,THiRD FLOOR <br /> STOCKTON <br /> 202 <br /> (209)468-3420 <br /> PUBLIC CORDSF-L SE A,PPLICATION <br /> APPLICANT—fYA 86AAD BUSINESSIAGENCY '1 o.'rA Q,1iPo.(Milr.l•Ir'At— 0,ps yTl4arr I rc. <br /> ADDRESS_A16-4 GIMP bAn+b' Svl'rr AD /!?NNrlGib Cotgd <br /> e <br /> PHONE �8� FACSDAILE <br /> rr <br /> TENTATIVE"APPOINTMENT DATE � 1D <br /> -Y , TIME -- <br /> -. <br /> (Please glue 7 10 usl ass days 11CM da ppli+cat' submittal) <br /> ® CHECK BOX TO EXPEDITE REQU T-$89.00 -RE S CESSED I BU ESS DAYS <br /> SIGNATURE OF APPLICANT �1"" - DATE J <br /> FILL ADDRESS THIS SIDE EHD STAFF-0413 DNLY <br /> PROGRAM ELEt,AENT '!9 '?4RCH <br /> A .3 .tet. lje';T IOM ME'S WE A041 M LM-- 11113 <br /> dS s iy Sfkr'i 1 <br /> av6 „rr~ Sf E fie„ C* sy.4-flisd I I i R o <br /> X3-45 d t✓a c CA -rX IPAI 0144 n <br /> - - <br /> ENVIRONMENTAL HEALTH DIVISION FiLES <br /> ;ya"j's <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT D SOLiD WASTE FI.LTTY <br /> ❑ 9THER CLEANUP SiT>:(NON-IOP) 0 FOOD FACILITY CI SOLID WASTE V TCLt= <br /> UNDERGROUND TANK(MONITORiNGIREMOVAL) O 000 KENNEL O DAIRY � <br /> E3 dAZARDOUS WASTE GENERATOR D CHICKEN RANCH 13PKG TREATMEWAANT <br /> Q�TIERED PERMITTED FACILITY 0 MOTEUHOTEL 0 PUMPER TRUCK ?CHEM TOILETS <br /> 0 TATTOO/BODY PEIRCING E3POOLISPA O LAND USE APPL 1 4*014 SiTES <br /> ❑ MEDICAL WASTE FACILr1Y ❑ PUBLIC WATER SYSTEM CI OTHER(PLEAS!✓5 CIFY ABpVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list ftovb by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (2091.464-d' or mail to the <br /> ad Less Indicated above. <br /> Z. EHD will notify the applicant if any EHD flies exist. An Appointment for review will b�e;Conff rmed <br /> approximately five business days but no Inter than ten(10)days after recelpt of aptooklon. The files <br /> Will be held for a maximum of five business days for review. Appointments should b_'idebaduled <br /> r <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately avallabf4for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future fife reviews by the same applicant may require a$89.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 's. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE. TIME l'• -- <br /> DATE CONFIRMED PHONE FAX iNITIALi <br /> L.REVIEWED— YES NO REVIEW DATE <br />