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1'%28/2004 13:24 FAX 209 948f 7• ^� ���•• '"" " <br /> DATF"•RECEIVED SAN J OAQUIN COUNT,Y <br /> jll <br /> E+NYIRONMENTAL HEALTH IDEPARTMENT <br /> 304,E Weber Ave 3d Floor Stockton; CA 95205 <br /> (209)468-3420 Fax: (209)454-0138 Web:VrWW-Co.,1 nn joaquiu.ca.&ehd <br /> PUBLIC VXCORDS RELEASE Ir? ON <br /> Al <br /> pppiJCANT Y •��-,r• ' ��� BUSINFSWAGFNCY; # e1 <br /> FACS=MILE; a <br /> PHONE; <br /> TENTATIVE'APPOIN MENT DATE: 1I C7� I Tcna: — <br /> (Please allow 10 business days from date of application subsr 7d 1) <br /> 1 ❑ CHECK BOX To EXFEDrTE REQUEST-$99-0e FEE—REQUEST PFtOCMr:D K3 WANESS DAYS <br /> SIGNATURE oi'APPLICANT i '"-✓�. �} DATA <br /> ' �l Department Use onto <br /> FILE ADDRESS 4 uNlr <br /> IEm l I Unit t <br /> x swtet3- SUM* <br /> U.I�o� r fon Unit2 11 <br /> 11111,11,11, TLCP41� orf -e <br /> S. Sbed 1 � x <br /> !! <br /> } <br /> Unit <br /> 'r. shed Ut <br /> ia, sarer.� _s. sMeeS ,�. <br /> . <br /> ENVIRONMENTAL HEALTH pEPARTMF-NT FILES <br /> I! <br /> 0 HOUSING ABATEMENT 49 Sol_ID WASTE FACILITY <br /> UzL UNor,-RGROUND TAMC(U"CLEANUP SIVE(LOP) <br /> Q FOOOFACILfTY ! ❑ SOLID WASTE VEHICLE <br /> 19 OTHER CLEANUP SITE(NODI-LAP) 13 DOG KENNEL VAIRY <br /> 0 UNDERGROUND TANK(MONITOMO R>:N14VAL) 0 CHICKEN RANCH ! R PKG TREATMENT PI.A TC <br /> F.l HAZARDOUS WASTE GENERATOR 0 MOTBI AiOTEL � 0 PUMPER TRucKIYARDtc"EM TOILETS <br /> 0 TIMED PERMTCTE-D FACILITY ❑ POCHISPA VIL LAND USE APPLICATION SM <br /> ❑ TATTOCMO 7Y PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> t3 MEDICALWA.STE FACIL"Y Il. <br /> 1. List up to ten addresses in the space above- Select the type(a)1of files frog the list aboWe py checking <br /> type MST bei elected. Fax to 209 464-0438 or mail to the <br /> the appropriatebox(es). At least one file <br /> address indicated above_ w will be confirmed <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review <br /> approximately five business days but no later than ten(',10)days afte�e��t of aPPlicati <br /> d be scheduledTFles <br /> wi11 be held for a maximum of five bus•Iness days for reiiew. Apps . <br /> accordingly. <br /> 3. Afile that Is actively being worked on by EHD staff may not be:immediately available for review. A new <br /> a be submitted when the file is availab a ztise <br /> application inay <br /> 4• Any file not returned in the same condition as released., be{reorganized by EHD staff at a xpe <br /> of the applicant Future file reviews by the same applicant may require a$93.00 deposit Prior to review <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff, <br /> s, Applications received after 3:00 pm will be processed the next business slay. <br /> TIME _}3rz__ r.• <br /> MED <br /> ' -{I+tITIALS 'r <br /> SATE G.OIV�IRNtED rc'•� p146NE - J FAX . ,t :1 --7-7 ' <br /> iYES 'NO REVIEW DATE' <br /> f. 4 <br /> p,EME-WED <br /> ENn 4aa2.00e i' <br /> 679!.2001 . . <br /> i� ' <br />