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tt9 +3 U©0 11:"' 4I FRU US SI'4L4 P���--0yyy�....1��'��'�,,,, tom' <br />P4TL NL{ £MD 1041iUM8cR9�/0'\ <br />`�Yws SAN JOAGtIJiN COUNTYPUELIC HEALTH SEALS <br />+.•_ ENWIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTONCA952)2 <br />d)PPUBLIC <br />a; ✓ ,tom <br />0. <br />(209) 468-3420c2 <br />68-3420 <br />c2IV RECORDS RPLf=ASI,APPLICA[{ON (i; <br />.TCh i-7 e r f iy t f J <br />APPLICANT () y >;USINESSIAGENC}YvIS�1�•✓ ifS=rDC/L.dLG <br />'ADDRL-3 L[1J$�5 `,,PV6j,a �7d)✓)-t .5u:) --e Il)--CXog OF. 6%,�t-(Chja`/� YSp 6 <br />�HOiiE -i2. gl ! G- 7 2 FACSIMILE <br />TENTATIVE" APPOINTMENT DATE <br />(Please give 7 I I t awines6 days from (FIFO>F appiieaGon submittal) <br />CHECKeQXTOEXPEDREREQUE •$67.00 FEE- gFQEJEST PROLE: -)SEI I IN 3 BUSINESSDAYS <br />SIGNATURE OF APPLICA DATE <br />i <br />TADDRESS <br />THIS SIDE EHD STAFF USE ONLY <br />PROGRAM <br />#MAN�L��_I <br />mm� <br />ENVIRONMENTAL HEALTH Di /]SION FILES <br />P1,UNDERGKOUN❑ TANK (UST) CLEANUP SITE (LOP) R HOUSING ABATEMEI IT a SoLtO WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) O, F000 FACILITY M SOLID WASTE VEHICLE <br />UNDERGROUND TANK(MONITORINGIR.EMOVAL.) ❑ DOG KENNEL 0 DAIRY <br />HAZARDOUS WASTE GENERATOR O CHICKEN RANCH El PKG TREATMENT PLANT <br />CI TIERED PERMITTED FACILITY 0 MOTEUHOTEL ❑ PUMPER TRUCKrvARD(CNEM TOILETS <br />I7 TATTOO(BODYPEIRCING 0 POOUSPA -' ❑ LAND USE APPLICATION SITES <br />t7 MEDICAL WASTE FACILITY O PUBLIC WATER SYS'; EM M OTHER (PLEASE SPECIFY ABOVE) <br />'I. List up to ten addresses in the space above. Select the types) 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. <br />2. EHD will notify the applicant if any EHD flies exist. F,n appointment for review will be confirmed <br />approximately five business days but no later than ben (Io) days after receipt of application. The files <br />will be held for a maxImUm.Gf five business days for rev gw. Appointments should be scheduled <br />accordingly. <br />J. 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,vill be reorganized by EHD staff at the expense <br />of the applicant. Future file reviews by the same applica-nt may require at $87.00 deposit prior to review. <br />5. 'TENTATIVE appointment dates must be confirmed with EHD stall. <br />6. Applications received after 3.00 pm will be processed th a next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO _ REVIEW DATE <br />TOTPL: P.01 <br />