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tHD LOU NUMBER <br /> DATE RECEIVED • SAN JOA.QUTN COUNTY <br /> �NYTRONMENTAL HEALTH A.E1 FARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209) 464-0138 Web: www.co.san joaquin.ca.0 hd <br /> 01 <br /> P(JBLIC RTCORbS RPLEASE, gAPPLICATION <br /> APPLICANT' t"'^'1 �!ld_- -1 BUSINESSIAGENCY: fV�`-1 /`R�✓""`S � '4 '�r _ <br /> ADDRESS: .1 -1 vv Ck^ L044 t, <br /> PHONE: 36--'t- ..J ) FACSIMILE: -' a <br /> TENTATIVE*APPOINTMENT DATE:,,.--10 a Time: <br /> y�F-�--.-- <br /> (pteasc allow 10 business days from data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FE -REQUEST PROGESSED IN 3 BUSINESS DAYS <br /> ���� DATE 3 <br /> SIGNATURE OF APPLICANT _�3 DppanmcntUse Only <br /> UNIT <br /> FILE ADDRESS <br /> t. .^,veer I-Z:7 S �o.0-Yam 5k- Glr Low'' '� P0 (f•O G.A Unita <br /> 2. Street 1)Z S• SaC.r S�-' <br /> co C] Unit 23. Street <br /> J <br /> 4. Street ✓h 19�,V Q Gti <br /> S. street Cl[ nit3. <br /> cu <br /> B. <br /> S1,001 Unit 4 <br /> Glt <br /> 7, $Irfel <br /> B. sumer [] Unit 5 <br /> ,v <br /> q Street <br /> 10. street ` <br /> ENVIRONMENTAL HEALTH DIE TME9 FILES <br /> ,?:LHOUSING ABATEMENT O SOLID WASTE FACILITY. UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 12 FOOD FACILITY E3SOLID WASTE VEHICLE <br /> 6L OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL ❑ DAIRY <br /> �} UNDERGROUND TANK EN RITORINGIREMOVAL) ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ MOTEUHOTEL d PUMPER TRUCKIYAROICHEM TOILETS <br /> TIERED PERMITTED FACILfTY ❑ POOUSPA O LAND USE APPLICATION SITES <br /> Q TATTOOIBODy PIERCING O OTHER(PLEASE SPECIFY) <br /> 0 MEDICAL WASTE FACILITY <br /> I. List up to ten addresses in the space above. Select the type(s) of files from the list above 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. xist. An app <br /> . y ointment for review will be confirmed <br /> 2. EHD wilt notify the app Fant if an EHD files e <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <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 new <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 EMD staff at the expense <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 EMD staff. <br /> B. Applications received after 3:00 pm will be processed the next business day. <br /> -------------- <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE �/ ^ <br /> ENO 60-0A•ea5 Ov -.I d - ( V `_ ' U J I <br /> 19 �(/�J✓•Q�l' l�1 (��Q J' <br /> I( I 0'1 ai <br /> ! J <br /> 1 (1n. . n '4- n�lrl ( A <br />