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VN <br />J'3 <br />�,.�.Cv�y GIY`/iRVIYI•IGIYI liL. ntraLln IJALE � <br />7AN JOAQUIN COUNTYPUBLIC HEALTH SERVI <br />l i ENVIRONMENTAL D EASST WEBER AVENUE, THIRD LTH DIVISION <br />g 8' <br />STOCKTON CA 95202 <br />02 JUr,'' F£; fi1�110: 'pj1gLiC RECORD39) 468-3420 <br />RELE,gSECCAPPLICA7'I0N <br />APPLICANT a BUSINE&WAGENCY_ T' JT <br />PHONE 5I0IJq_gZW ^�[_�FACSIMILE 'J 0— - -I— <br />TENTATIVE• APPOINTMENT DATE ASA <br />(Please Olve t0 0 busines�s d sfrom dal f app11 , suhmll _1 <br />I 1I • <br />CHECKBOXTOEXPEDITERE E T.j19, 0 m (VEST p�CE I SINESS DAYS UN 2 <br />SIGNATURE OF APPLICANT DATE b I F OZ <br />� IaI IJ ' I U1. �ffllGl l�r--1rJ�.��wl�- <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />ial UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />O HOUSING ABATEMENT <br />in SOLID WASTE FACILITY <br />O OTHER CLEANUP SITE (NON -LOP) <br />O FOOD FACILITY <br />O SOLID WASTE VEHICLE <br />❑ UNDERGROUNO TANK (MONITORINGIREMOVAL) <br />❑ DOC KENNEL <br />❑ DAIRY <br />�CHAZARDOUS WASTE GENERATOR <br />0 CHICKEN RANCH <br />0 PKG TREATMENT PLANT <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />ial UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />O HOUSING ABATEMENT <br />in SOLID WASTE FACILITY <br />O OTHER CLEANUP SITE (NON -LOP) <br />O FOOD FACILITY <br />O SOLID WASTE VEHICLE <br />❑ UNDERGROUNO TANK (MONITORINGIREMOVAL) <br />❑ DOC KENNEL <br />❑ DAIRY <br />�CHAZARDOUS WASTE GENERATOR <br />0 CHICKEN RANCH <br />0 PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY <br />❑ MOTELIHOTEL - <br />❑ PUMPER TRUCKIYARDICHEM TOILETS <br />❑ TATTOOISODY PEIRCING <br />❑ POOLISPA <br />O LAND USE APPLICATION SITE$ <br />0 MEDICAL WASTE FACILITY <br />17 PUBLIC WATERSYSTEM <br />0 OTHER (PLEASE SPECIFY ABOVE) <br />1. 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. F_ax to_(209) 464-0138 or mail to the <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 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 aetively being worked on by EHD staff may not be immediately available for review. A new <br />application may be sOmitted 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 expense <br />of the applicant Future file reviews by the same applicant may require a $99.00 deposit prior to review. <br />5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />a. 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 />uaisae <br />Z020'd 8£T0b9VG0ZT 01 ad D£:01 Z00Z 8T Nnf <br />J <br />0 <br />