Laserfiche WebLink
04/04/2005 15:53 20936942 NEIL ANDERSON ENO PAGE 02/0 <br /> .." DATE_RECEIVED <br /> CFD LOG Nl F_R <br /> SAN JOAQUIN COUNTX n ",. <br /> ENVIRONMENTAL HEALTH DEPARTMF;NT7 <br /> 304 F Weber Ave 3r1 Floor Stockton., (�� <br /> (209) 4683420 Fax: (209) 464-0138 Web: www.co.san.-j't3a�1 . KS@d3' : <br /> SAN <br /> PUBLIC RECORDS RFLEJU,^UU OUM1'Y <br /> A,SE A,�' 1W%UOUN _ <br /> 0-4-1 <br /> T BUSINESS/AGENCY: <br /> ADDRESS: _ �l�,a ��—V�(� ` 1A.4�9'1 \. 5 <br /> PHONE: CJ"► L FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE–REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �y DATE , I—( <br /> Department Use Orl <br /> FILE DRESS UNIT <br /> +, -�7 I \ �� w <br /> Z � �� � <br /> Street ❑ Unit 1 <br /> Jdi <br /> City ...rIu ,I <br /> 141 <br /> Cry <br /> 4. so-ppt n 1rJ E] Unit 2 <br /> r..n0 <br /> s. street City Unit 3 <br /> 6. Strect <br /> 7. street 2 , (lo �?o Ctty _ F Unit 4 <br /> 0. Street _ _ (t� e <br /> 2. Slroct _ _ GI OA A N�/� v,�J, <br /> 0, Street (�. jLM�I ��� t �— T LLJI' Unit 5 <br /> ' C ty <br /> p . <br /> ENVIRONMENTAI.HEALi4 1 � <br /> OL UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING A13ATEMEN_T__ X SOLID WASTE FACILITY <br /> � OTHER CLEANUP SITE(NON-LOP) rJ FOOD FACILITY h r'— LID WASTE VEHICLE <br /> PhUNDERGROUND TANK(MONITORINGIREMOVAL) C1 DOG KENNEL 5 RY <br /> 6a� HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL d PUMPER TRUCK/YARDICHEM TOILE <br /> ❑ TATTOO/13ODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by check <br /> the appropriate box(es)- At least one file type MUST be selected. Fax to 209 464-0138 or mail to t1' <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application, The fill <br /> will be held for a maximum of five business days for review_ Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A r <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the exper <br /> of the applicant_ Future file reviews by the same applicant may require a$93.00 deposit prior to revi <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED ,APPOINTMENT DATE � TIME <br /> DATE CONFIRMED _ PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />