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SAN JOAQUIN.COUNTYPUBL1C HEALTH SERVICES <br /> il� fl' :ENVIRONMENTAL HEALTH OM�N <br /> ��J'�::_'• :.'. O 304 EAST WESER AVENUE,THIRD FL R <br /> -STOCKTON GA$5202 � fC <br /> f J U L 1 1 U u'l (2119) 468-3424 5: <br /> PUBLIC RECORDS REUSE APPLICATION <br /> 'Fr <br /> APPLICANT-ugBUSIX15SSIAGENCY <br /> f AODREss /�►� �/ //� D/Q'd C, /S�t S-- /!. . <br /> PHONE D-� .I �lLlQfLI FACSIMILE .2' <br /> TENTATIVE'APPOINTMENT DATE TIME es <br /> Mkilas give 7 to 10 busineFr,days ft-con dAa of appliaadan submitwo) <br /> �ifJ%15 3. <br /> CHECK BOX TO F-)WEUrrE REQUEs*r_$7 -R UEST PROC1E33ED 1H 3 BUSINESS DAYS . <br /> SIGNATURE OF APPLICANT . „� . _._ DAME JJAJ It <br /> >� <br /> FILL=ADDRESS <br /> CAL 1'LM;A5k <br /> NFF� <br /> 2k av C <br /> \NF l~ 1.0 <br /> zy\E- CS <br /> V <br /> y �l1ti <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(u-5,T)CLEANUP SITE(LOP) 0 KaUSING ABATEMENT 0 SGLIV WASTE FACILITY <br /> RTHE"CI"NUP SITE(NON-LOP) Q FOOD FACILITY O SOLID WASTE VE113CLE <br /> 3*UNDERGROUND TANK(MONITORINGrREMOvAL) E1 DOG KENNEL 0 Q,IRY <br /> HAZARDOUS WA5YE GZNC RA'TOR ❑ CHICKEN RANCH 13 PKG TREATMENT KANT <br /> 0 TIERED PERMITTED FA{:1LrrY 0 MOTELIHOTEL 13 PUPPeRTRUCKFYARDlCHEMTOLETS <br /> TATTOOiBODY PEIRONG n POOLISPA O LANID USE APPLICATION SITES <br /> la MEDICAL WASTE FACILRY Q PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> I List up to tan addresses in the spam above. Select the type(s) of files from the list above by checking <br /> the appropriate bwges). At least ane fila type MUST be setectd& Fex to (248)464-0138 or mail to the <br /> ' a�ssindicated�bnve. ' . <br /> 2. EHD,4vill notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately fivo lousiness days But no later than ten{10) days after raceipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments sfluuld be scheduled <br /> accor+di ngly, <br /> 3. A file that is actively being worked on by EHO staff may not be Immedlately available for review. A new <br /> application may be submitted when The file is available. <br /> 4. Any file not returned in the same wadition as released will be rearganized by EHV staff at the expense <br /> of the applicant. Future'file reviews by the same applicant may require a $78.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with END staff. <br /> B. Applications received attar 3:011 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED _ PHONE FAX INITIALS <br /> REVIEWED YI-S NO REVIEW DATE <br /> ai 00 14 alIA&M <br />