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i'uiofcooa ii:w rAe zva U40Ub Z1 . 10002/002 <br /> �1DATE RECEIVED -- <br /> SAN JC A Q11N COUNTY <br /> \V ��I1 D ENviRONI�LENT�,LaHEALTH DEPARVYitNT <br /> RECE <br /> `I 304 E Weber Ave 3 Floor Stockton, CA 95205 1 ? 79ZJUL 1 L C{ M68-3420 Fax: (209) 464-01:,8 W:b:rnvw-co.saajoaquin.ca-&ehd <br /> ,:,,,1IRGMNMCT HEA-WSUSLTC RERRELSEiASElA5'P�P�YLrFI@CJ�A+�T <br /> 11 <br /> 3ENCY:APPLICNI✓ 9USINESSIA <br /> ADDRESS_ dFRE ged M46C!ie�"�"�"SI _ <br /> (A 9��';- <br /> PHONE: (a$ �13H7- _FACSIMILE: Lapa) Q4?^ wo.-i -'Mill <br /> TENTATIVE*APPOINTMENT DATE: Tme: 10-11i <br /> (Please allow 10 business days Imm date of appOcrtion submittal) <br /> CHECK BOX TO EXPEDITE RECUEST 497.00 FEE-RECUEST I°ROCESSED IN 7 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ��3 } <br /> \ \ Qeoadment Use 0* <br /> FILEADORESS �- UNIT <br /> 1+_�)I LAST �. su a ani IQIIa cg !-adf p Unit 1 <br /> F x sued bol tt Tt> �� 'r <br /> nitz <br /> s. slew a! $ Unit 3 <br /> Si6. d! ///---/� <br /> r. svec -- Unit 4 <br /> 0. Slo-a( Gr• <br /> Unit 5 <br /> 'ENVIRONMENTAL.HEALTH DEPARTMENT FILES snow <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSINU AB aTEMEHr St(.SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ F(00 FP CILrIY CI SOUR WASTE VEHICLE <br /> I& UNDERGROUND TANK(M ONITORINGIREM OVAL) ❑ DOG KEIINEL P-DAIRY <br /> Z HAZARDOUS WASTE GENERATOR ❑ Ct IICKEt.RANCH Ii TREATMENT PLANT <br /> In TIERED PERMITTED FACILITY ❑ MOTEIJFAi1:L ❑ PUMPERTRUCKIYARDICHEMTOILETs <br /> IA L <br /> ❑ TATTOcii PIERCING 0 P(tOUSF A AND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O O'HER(°LEASE SPE=CIF`!) <br /> 1- List up to ten addresses In the space above. the types) of files from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD'iles exist An appointment for review will be confirmed <br /> approximately five business days but nc later than ten (10) days after receipt of application. The files <br /> will be held for a maximum of five busin iss d lys for review. Appointments should be scheduled <br /> accordingly. <br /> 3 —A file-that is-actively-bein"oriwd an-b} HID staff may-not-be immediately-availabte for review.. A-new -- — <br /> application may be submitted when the 'ile is available. <br /> 4. Any file not returned in the same Condition as released will be reorganized by EHD staff at the expense <br /> of thelapplicant Future file reviews by i he same applicant may require a 593.00 deposit prior to review <br /> 5. `TENTATIVE appointment dates must b(: confirmed with EHO staff. <br /> B. Applications received after 3:00 pm will be pracessed the nextbusiness day. <br /> :GON -[Wii-(]i)1P...ROINTMENT te,.,7E' <br /> DATE CONFIRflED PHONE . FAX ` '' INITIALS <br /> REVlE1VED YES NO REVIEW DATE. <br />