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12/03/2003 09:09 CLAYTON GROUP 4 12094640138 NO.404 6 <br />PAGE 81 <br />11/20/2003 .12:50 4640138 • <br />ENVIRONMENT- <br />AL <br />tHU Lull MUAAiSC1C <br />OATi:R �`//'jL�'j-:) - SAN JOAQUIN COUNTY <br />1`- I=' N.IRONMENTALHEALTFIDEPARTIVIENT <br />DEC 0 3 2003 304 E Webcr Ave 3`d Floor Stockton, CA 95205 ca uslehd <br />((209) 468-3420 Fax: (209) 4-64-0138 Web: www,co•san joaq <br />ENVIHONfviENi HEAL(H <br />PERM11*6ERVICES PUBLIC RTC4�351t�XBASE APPLICATION S <br />� <br />c (� eUSINESSIAGBNCY: C4(` <br />APPLICANT-.jefl4- <br />ADDRESS: dqa®K!7) 025 <br />iib- Lj�G –�Jiob <br />926 o�bd}�7 FAcsIMLE: `>inr^> <br />PHONE: �" *•;.^ <br />( IiC 1 <br />' TENTATIVE' APPOINTMENT GATE: Ilcellon submHtal) <br />(pieasn allow 10 huslness days from datelcr opp <br />Q CNEGK BOX TO EXPEDITE REOUE3T • .ao FEE - REQUEST PR S I ED IN ] tfUS�NE55 DAYS <br />SIGNATURE OF APPLICANT'. � Deoaej1n;Use ONV <br />UN -T <br />iA NOERGROUND TANK IUST) CLEANUP SITE (LAP) <br />THER CLEANUP SITE (NON -LAP) <br />NDERGROUNO TANK (MOWTORINGtREMOVAL) <br />H=000S WASTE GENERATOR <br />G TIERED PERMITTED CAGILITY <br />I] Unit 1 <br />C3 Unit 2 <br />Unil 1 ' <br />Ok Unit 5 <br />O HOUSING ABATEMENT O SOLID WASTE FACILrrY <br />O SOLID WASTE VEHICLE <br />VCQ�D FACILMY ❑ DAIRY <br />M KENNEL 0 PKG IREATtaENT PLANT <br />CKEN RANCH p pUMPERTRUCKIYARDfCHEM TOILETS <br />7E11HOTELp p USE APPLICATION Srraas <br />0 POOUSPA - I,.�, c, /V�Aib"I• 1�L <br />O TATT001800Y PIER 07HER (PLEASE SPECIF'n,%1fdP®. — heckin <br />❑ MEOICAL WASTE FACILITY e s Of files from the Gst above by <br />At least one file type MXjST be Selected. Fax o 2D9 d64 0138 or mail fo t c <br />1 List up to ten addressee in the space abav0. Select the typ <br />the appropriate box(es).MOO <br />address in is ted above, ointment for review will be The Tile: <br />EHt) Will notify the applicant if any EHD tiles exist. An appointment after receipt of application. <br />2. ointments should be scheduled <br />approximately five business days but no later than ten Sio) ay <br />Will be held for a maximum of five business days for review, b�pmmediatety available for review, A n <br />accordingly. May <br />3, A file that is act/ Se submity gtted when the fi Iworked on by s available. EMD staff at the exper <br />appttile on may <br />the same applicant may require a $93.00 deposit prior to rev <br />} Any file not returned in the same condition as released will be reorgan�e Y <br />of the applicant. Future lite reviews by <br />5. TENTATIVE appointment dates must l e processed <br />d 06 n° t business day, <br />E Applications received after 9:Oa pm w111 be processed th <br />TIME <br />C0NF" RME0 APPOINTMENT DATE PHONE FAX INITIALS — <br />OATECONFIRMED REVIEW DATE <br />REViFWEO <br />YES NO <br />