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10-07 _4640138 ENVIRDMIEN7RL HEALTH PAGE 61 <br /> ,I,s "ti f NAM J OAQm C01 TT'Y —- --- - -�� <br /> ENVIRONjV)ENTAL&ALTH DEP,ARTMEN'i<'` <br /> / 7 20 - 304 East Weber Avt�Lue,3rd Floor,Stockton,CA 95202-2708 <br /> elephoee:(209)468-3420 rx'x:(209)464-0138 Web:wwwsj&Dv.org/ehd ' <br /> ENVJRQNfvitN- i T �o <br /> pERPviIT/SCRVICES 6LZC ILCOUS MLEAn APPLICATION <br /> A?PLlCAhfT: gusa�ssraaatcr: ; Hu►1k;�,1 '� ,�' <br /> d <br /> PHONr-(I C6o a PHOUEc�: �{L(�Qledll F s7o)�u4—baa <br /> TENTATIVE:APPO Kri MIT DAM T(me <br /> (Pk=990w is bw4m=Ear:trom cSirto nr ,pga�ton .•r ��only. rr <br /> MEM BOX TO 07MM •i9s AoFM(GASH M CHC-CK ONLY)-IdwO=T PROC=ED IN s ri SMS DAYS <br /> `SIGNATURE OF APPLICANT DATE <br /> 1"T° MWMN o U 4 a Wit jotAx i a oe,cr <br /> 6boct FI ADDRESS <br /> E"D USE ONIrY <br /> JJ✓✓' '`� b -77 <br /> 2. <br /> fi{ w -_�Ldfz <br /> 4. <br /> 7.$ <br /> �• J <br /> o. <br /> 'SP00109 Wto Range of k0bmtat3on Requested:From to <br /> ENVIROUMENTAL HVALTH DEPARTMENT FILES Uj <br /> UO3WXGMM TAM(UST)TLEAMP 1UM(LOP) E3)fUtlsja Az 9 W eRr J1Csa j0 W"nF�E <br /> omm elx� s m(tet oF7 a Food Fay w Tait <br /> UN XAGRUM TAW(M Mme' FAQ E3 E=KEWEL P 0AIKY <br /> Hi s w,�sre GEt�AToa ❑Crp RuxxS p w fAM TF SAT&OXT PLAW <br /> 4(T0=PV%"1W FAQX= d a Pi t T%)=YA a TATS <br /> D Tfi'trroolswy PIM=2 o PooLnm n)WLAw Use ArPLM stnx <br /> Mmr-ALWASTe FAMM , 01 c(ptEtise srmv Q i� ,LL{s��'�' '2 a o^rhe• -2�it <br /> WELL Arm ZGKW Peaar R=RbS ARE JAMAMS FOR ReyOr• MOt•{IMY-FAY t 40 AM-6 FII - 0s HOLIDAYS, <br /> r. - <br /> 1. L.Ist up to,tan addre-ses in the space above- b°eleet ttK ty*s)of files from the list above by cheeidrk:g the <br /> appropriate boxfes) At least cot:file tyke MUST be selected. rax,to p"4sd-0939 or mail to the address <br /> 110joW ak2ye.I Address ranges will hot bo accepted-for additional assistance wfth file addresses,eanfiact <br /> tht EHI].Applications received arfEer 3:00 pm will bo processed the next business day. <br /> 2. The EKE)vrilt rioft the applicant if any ERD ties exist, An appointment for review vwJ0 be confirmed <br /> approximately ten(10)dap After receipt of applicutlom The files will tae held for a maximum of five business <br /> days for review. Appointments vhould be scheduled accordingly. <br /> 3. A fDo that is actively being worked on by EHD staff may not be Immediately awa.Ila.ble for review. A new <br /> applirat)on may be submitted when the file is available. <br /> 4. Any fila not returned In the same conditlon as released will by mr9antzed by EHD&taff at the expense of the <br /> applicant. Future Me reviews by the same applicant may require z$93,4 depositprior to revlew. . <br /> V <br /> TO 39dd GNVIAVO OHd LBZ6897,915 VC:ZT 509Z/LT/TT <br />