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08/16/2004 16:20 FAX 209 9480621 0 002 <br /> Cl L/ <br /> 1 , rip q/�o tJ la^Aq'� <br /> - EHP LDC NUYElEA <br /> ATEi �� [-SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL- HEALTH pIVISION <br /> AUG 16 2004 304 EAST WEBER AVENUE, <br /> NU ,THIRD FLOOR <br /> jq5 <br /> STOcKTO <br /> ENVIRuivfvlEf�T 7 <br /> HEALTH (209) 468-3420 <br /> PER1,!1T/SERVICES PUBLIC RECORDS REUSE APPLICATION <br /> CANT �`p�l�J rU BUSINESSIAGENCY <br /> ,�po <br /> ADDREss gc� 5- / l ile 51'.. <br /> '� <br /> � � <br /> PHONE FACSIMILE <br /> ���' /Y <br /> oo <br /> g �p Q TIME <br /> TENTATIVE'APPOINTMENT DATE licatlon submittal) <br /> (Please Hive 7 to 10 business days om date Cf SPP <br /> q3,ao IN 3 BUSINESS DAYS O <br /> CHECK BOX TO EXpF-DRE REQUEST'SPM EE,REQUEST PROCCS <br /> DATE <br /> SIGNATURE OF APPLICANT ' <br /> 1 1LE ADDRE55 THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> KC <br /> 0 <br /> ac <br /> bac r✓ r;:, <br /> L�4r e7 _,40 f0, Q <br /> 1 ,craw , <br /> 121 <br /> �/(; c v� 4c L,-4A" <br /> ENVIRONMENTAL HEALTH DIVISION FILES `Ty <br /> HOUSING A6ATI=MST Souo WASTE FACi1-1 <br /> UNDERGROUND TANK(UST)CL-EANUp SITZ=(LOP) O FOOD NG Aa T SOLID WASTE VEHICLE. <br /> OTHER CLEANUP SITE(NON--OP) DOG KENNEL DAIRY <br /> ❑ <br /> UNDERGROUND TANK(MONITORINGlREMOVAL) '�PKG TREATMEW PLANT <br /> ❑ CHICKEN RANCH ❑ PUMPERTRUCIVYAMCHEMTOlI <br /> HA7ARDolfs WASTE GENERATOR ❑ II,IOTEL/}IOTEL ., 'LAND USE APPLICATION SITES <br /> TIFRED PE MITTV0 FACILITY [3PpOUSPA ❑ OTHER(PLEASE SPECIFY A50V� <br /> ❑ TATTOOfUoDY P❑RCING ❑ pUBUC WATER SYSTEM <br /> ❑ JAEDICAL WASTE FACII-11Y checking <br /> List up to ten addresses In the space above. Select the types)of files from the list above by <br /> 'l• a MUST be selected. ax to 209 464-0138 or mail to the <br /> the appropriate box(es). At least one file type <br /> address indicated above. . ointment for review will be Co on'mThe files <br /> 2- EHU will notify the applicant if any EHQ files exist. An app days after receipt of app <br /> approximately five business days but no later than ten(10) y ointments should be scheduled <br /> will be held for a maximum of five business days for review. App <br /> accordingly. eing worked on by EHD staff may not be immediately available for review. A new <br /> 3. A file that Is actively b <br /> application may be submitted when the file Is available• anlZed b EHD staff at the expense <br /> 4. Any file not returned in the same condition as released will be reorg Y <br /> of the applicant- Future file reviews by the same applicant m teff <br /> staff- <br /> -TENTATIVE appointment require a $87.00 deposit prior to review, <br /> with <br /> 5. E intment dates must be confirmed <br /> 6. Applications received atter:3.00 pm will be processed the next business day. N> <br /> CONFI:QNFIRE-D <br /> ED APPOINTMIENY DATE <br /> TIME.. <br /> DATEPHONE FAXINITIALSCM <br /> oc�JtGVU r1ATF —' f <br />