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VIRUNMENTAL HEALTH DIVISI - <br /> 304 EAST WEBER AVENUE, THIR FL,O : . <br /> / x STOCKTON CA 9520235,5 <br /> �v {209)463-3420 <br /> UB LI C RECO RDS REL APPLICATION <br /> APRLIC:ANT" t e f' BUSiNESSIAGENCY Iii UCUiCi? <br /> ADflREss (J S`" Wl 1 s C CA 5-- Q <br /> PxtaNE r?t] ,/Ur� FACSIMILE / / <br /> TENTATIVE'APPOINTMENT DATE "; 4"" TIME � <br /> ZS.i�[ - <br /> {Pleas*give 7 to 10 busing days from data of application aubmittai) <br /> r-HECK 9OX TO EXPEDITE REQUEST-7DQ FEe EQUEST PROCESSED IN 3 BUSJIESS DA - <br /> f A <br /> SIGNATURE OF APPLICANT ®ATE SLm-4 <br /> iii <br /> FILE ADDRESS <br /> �J�F ,p"7 Atr <br /> AFF -mit <br /> .L • <br /> \f <br /> —4 2nol <br /> EN.VIRONMEN'' , <br /> UNDERI ROUND TANK(UST)CLEANUP SITE(LOP) ❑ tit <br /> OTHER CLEANUP SITE(NON-LOP) 11 FC <br /> UNDERGROUND TANK(MONITORINGlREMOVAL) Ci q1 <br /> ❑ HAZARDOUS WASTE GENERATOR 1:3 t:l <br /> 0 TIERED PERMITTED FACIIJTY 13 M <br /> 0 TATTOOIBODY PEIRCING El p. <br /> 0 MEDICAL WASTE FACIQ'FY 0 P1"� <br /> 1. List up to tan addresses in the space ab <br /> the appropriate box(es). At feast one fit <br /> Addross indicated above. <br /> 2. EHD will notify the applicant if any EIS <br /> approximately five lousiness days but n <br /> will be held for a maximum of five busin.. <br /> accordingly. <br /> 3. A file that is actively being worked on b <br /> application may be submitted when the <br /> 4. Any file not returned In the same coedit <br /> of the applicant. Future file reviews by <br /> 5. *TENTATIVE appointment dates must b <br /> 6. Applications received after 3:00 pm will <br /> CONFIRMED APPOINTMENT DATE <br /> HATE CONFIRMED <br /> REVIEWED YES NO <br /> EN 00 14 01105100 <br />