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11/ 20QS�lfl:(3i _ 4640138 EWIRONMENTAL HEALTH PAGE 01 <br /> F-NMONWMAL HRAT M DEP,ARTIENT <br /> a.,,✓ j 7 ja(f,-�,, 304 Fast}Veber Aweanq 3rd Floor.Stockton,CSA,95202-2708 i/11/���O <br /> 41lZoae:(209)462-3420 Sazr(209)464.0135 web:www4M oW&d�V`/ <br /> EPERN11T/S RVICESMENT HEALT UBUCRF,CORDSR=XAMAPPLIC&n0N V1 <br /> • APrucuir: fsusa+ass(Aoelcr: I L . k;arl_�_'� <br /> PHOHE(f 0 a? - prypHE FACSM11 F• S/0),tG4'-Qot07 <br /> TENTATWE'APPourn ITDATM rime <br /> (Pkssa dbw id tMcpwm der:hen date or appgaaon xtr6mNw.">•wdaUvN . <br /> ady-meat ba coN7cmecp <br /> CM=BOXT00TV)(MRE (9300 (-ASH MCHC=WL4 )-MWMTPROCMM1N3atLSytiEgsDAYS <br /> �UIGNATUREOFAPPWANT DATE <br /> LRai OLSTRtRUt10H O lMf!1 UnM.i A13Unh 5OPLIKS G oawv(dectraYU7strlqu=l <br /> EHDUSE <br /> FiC1 ADDRESS <br /> strode Y <br /> ' WOOName <br /> A. <br /> Z Q/f <br /> n�F F W- I��l <br /> 4. <br /> 7. <br /> 8 . . L <br /> 9. J <br /> 10. <br /> Speolgv pato Range of kftm ion Requeswd:From to <br /> ENVLRONUE NTA4 HEALTH DEPARTMENT FILES <br /> '8U utoTA (U5I)tLUjW1UW(LOP) ❑RaumuaASAngwr [dsounwAareFAatrTrA"ME <br /> OMM CLEANUP SM(Naa-LOPI O Food Ficnmr n wAM TZZE <br /> ISUMM MM TANK(MWWMWRW0VAL) ❑Do*KD0IEL PDAotY <br /> HA7AgO011gwfl GExmuMR d �rRunxl E3 WASn3YAMTRSATaExr Purr <br /> A(7arcco FSrtatrnrD Fuxin' ❑Nbtfl.Mote. O Puw&ERTRU:rtlYAR[Yg1Ea 7uaEis <br /> 10TATroof80oY1,0=9 'aPoa15PA ,ti'LumUseArrurATpNsistP <br /> oVXVMA-wATn:FAcK= ' >tErt(YteAse sPEar�• 'cf= i+fS' sr1.2n �rnA ,n <br /> ' WdL ANn SeracPeaar RD3aRbS ARE AVAnA�a-EIi7n IStYFSr• ItaafAY.FrtmAYd•00 AxSA0rN - paxlAtlG Han/.rs__ <br /> 1. Ust up to.ten addresses In the space above- S`etect the typos)of foes from the IM above by eheeid na the <br /> appropriate boges) At least one file type MUST be aoleoted. r:to f2Ds1464U739or mail to the*ddre£c <br /> ljoiotod a e- Address ranges wig not be accepted—for additional assistance whh file addresses,contact <br /> the EHLL Applications received after 3:00 pm wit[be processed the next businoss day: <br /> 2L The EKD will notify the appG=A If any EHD tiles exist An appotntment for review wig be confirmed <br /> approximately ten(10)days after receipt of applicatlon. The files will he held for a m=mum of flue business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A file that is actively being worked on by MID staff may not be Immediately avagable for review. A new <br /> application may be submitted when the file IS avauble. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the <br /> applIcatf, Future file reviews by the same applicant may require a$89.00 depositprior to review. <br /> 1tCi+W r <br /> 10 39Cd GNC-17N0 OWd LOZ689Z01:9 t+E:ZT 900Z/L1/i1 <br />