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08�,AMTQ <br />MDLG4 <br />ess <br />SAN <br />., ,r ENVIRONMENTAL HEALTH` �. <br />0, FAST WESER AVENUE, TWRD FLOO' <br />STOCKTON CA 95202 <br />0• 468-3420 <br />I■ (� �" � ■ t t ■ • � � ( ,�, . �" •fit <br />■ <br />n[.1 la $USIN63SlAGk KCY <br />4a- y `. <br />E �f. FACSIMILE <br />® n <br />* HTi}AT6 a <br />` ;• ;1 T£NTAT)VE ,a1 rvi"TtatE 1i td submittal) .; <br />ate of A <br />easy Siva to 40 u$Ineas da frwat Q pA �J <br />EST - $$T.00 FEE — REQUEST PROCE53ED IN 3 BUSINESS GAYS <br />DATE- <br />"GNA'rURE OF APPLICANT <br />;. <br />:ii•5 <br />I <br />FILE ADARE80, <br />IT <br />r rM+ 'r <br />MWAS <br />MISSION= <br />' <br />_ V <br />Us sIDE EHQ STAFF USE ONLY, <br />PROQRAPA ELEMENTS SEARC!L <br />'1"+ Z r 3t ENVIRONMENTAL HEALTH DIVISION PILES <br />jd SOUD WASTE FACILITY <br />GROUND TANK (UST) CLEANUP SITE (LOP) t7 HOUSING ABATEMENT Cl 80LID WASTE VEKICLE <br />CLEANUP SITE (NON -LOP) G FOOT} FACILITY fl DAIRY <br />GROUND TANK (MONMORING/REMOVAL) 0 DOG KENNEL DPKQ AIRY <br />PLANT <br />®Oils WASTE GENERATOR a CHICKEN RANCH 1l! PUMPER TRVCWARDIC ENI TOILETS <br />� p9 MITTED FACILITY CI POOLtSt3 dol j3PA NGTEL LAND USE APPLICATION rM8 <br />D1600Y P91RCING <br />hL WASTE FACILITY PUBLIC WATER SYSTEM O OTHER (P4>tASE SPEC{ :ABgVF} <br />List UP to ten Addresses In the space above. Select the type(s) of files from the list above Py checking <br />the appropriate box(es). At least one file type MUST be selected. FgS t2 r <br />InA <br />11 Inb <br />0-11)will notify the applicant if any EHD files exist. An appointment for review will be contirmed <br />pproXtmately fwa business days but no later than ten (10) days after receipt of applicafinh. The tiles <br />will be held for a maximum of five business days for revisw. Appointment$ should be scheduled <br />esc��rrdingiy. <br />AfiiE that is actively being worked on by EHD staff' may not be immediately available for review. A new <br />appue stion may be submitted when the file is available. i <br />Any Tile, not returned in the same condition as released will be reorganixgd by EHD staff at the expense <br />of the applicant. Future file raviews by the sams applicant may require a $87,01) deposit prior to review. <br />*TENTXi,'VE appoIntment dates most be confirmed with EHD staff. i <br />Appf(cath�,is received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOII�ITM£NT BATE <br />DATE CONFIRMED � PHONE <br />Mlw.611Gle1r'Y4 erre girl <br />TIME ®.. -- <br />FAX <br />1llt(T(AG,8 <br />6imVir-w nirrO <br />