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I Jan-08-05 09: 39A P_0 <br /> L.STF RSC�IVEC: ,., � ` c%1!]7C?G 5l'JMF� r <br /> ED <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 204 EAST WEBER A1I1✓I INE,TIHiRD FrLOOP <br /> t4N STOCKTON CA 05202 <br /> (209)468-34521 <br /> t ,p@NMENT LT1 PUBLIC RECD DS RELEASE APPUGATION <br /> APPLICANT_/ d[ G Cj /� _ �,. BUSINEMIAGENGY l /ZXJ�i iY l�lfy�__ <br /> ADDRE=SS /� / ��7 <br /> PRONE 'T -c7+t�9 I:ACSIMI'LE - <br /> ^"sen.- <br /> �•'• TATIVEE AFP0FN1�it;ZW'1 OA! r1 G `+f(fE DJ?7! <br /> 6W ^f <br /> (Please glue 7 to 40 busliress days ,?Wdate of application suhrniM[) <br /> j CHECK BOX TO F-XP>:t ITE REDUC-ST-$ 'rE A PROCESSED IN 3 BUSIN .f I <br /> SIGNATURE OF APPLIIAhT i] J <br /> —� . <br /> THIS SIDE Eno STAFF tISE ONLY <br /> � <br /> FILE Af3DRES5 ,�r 9 <br /> I PROGRAM ELEMENTS SEARCH I� <br /> - .tJ, F. - <br /> J) . <br /> g <br /> IrNVIRONMEN N L t#EALTH DIVISION FILES <br /> yRGf OUNQ TANK(U$T)CLEANUP frE(LOP) ❑ HOUSINU ABAT=Mt--Ti I M SOLID WASTE FACILITY <br /> HER CLEANUP SITE(4ON-LOP) n FOOD PAC:I`s." M ZMM t1 ASTE WHICLE <br /> _ N13URGmOUND TANK(MONITOPItJGREMCNAL) 11 DOG KENNEL j 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH M PKG TREATMEN-I PLANT <br /> M TIERED PER6TITTcb FACIUTY MOTELIHOTEL G F[JM12ER TRUCK ARDMHI;;Je TOILETS <br /> fJ POOLSPA 0 LAND USE APPLIGAnpN SITES <br /> I] TQ-l-Tt7r]IBOUY PEIRC�iNG I <br /> 0 MF-DICAL WASTE FACT'ITY M PUBLIC WA'1 R SYSTEM n M14FTZ(rLEASF_SPECIFY ABOVE) 1 <br /> I, List up to ten addresses in the space above. .1k!ect the type(sj of files from t"t!?St above by checking <br /> the appropriate box(es). At least one file type MUST be selected. i ax td 209 46d-073S or risail to the <br /> address indicated lha%fe- <br /> 2. EHD will notifv the aQplticant If any EHD files exist. An appointment for review will b Confirmed <br /> appmx)matply fives hercines.c rlaus but no Mier than teri if 0)days after receSpt of aPpfiCzti0n. The flies <br /> will he held for a maximurn of five business clays for review. Appointments should be subeciuied <br /> :accordingly. <br /> 3. A file that 1s a ctive:iv bL-ing worked Ort by F-HD staff may not b0 Irfli-61ed-is"atcly avalixn'i, for review. A now <br /> application may be submitted when the file Is available- <br /> 4. Any file not returned in the sawic condivion as retea,setl will bla reorgaviazed by EHD staff at the expense . <br /> of the applicant- Future file reviews by the sante applicant may require a$89.00 deposit prior to review. <br /> *TENTATIVE ATIVE appoint.-nen t rates insist he Uonfli,mad;Ellin EHD staff. <br /> Applications received after 3.00 pin will be processed the next businis:S 3av <br /> s E <br /> i Cr:3NPIRMED APPOINTMENT DATE= i TIME <br /> I �l <br /> DATE u4r4f'ipmEn 1 - PliONE i FAX INITIALS <br /> REVIF-WE 7 YES NO . REVIEW BATE <br /> i <br /> l <br /> I <br />