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• 06/03/2004 10:24 20946719 AGE STOCKTON PAGE 01/13 <br />DATE RECENED <br />SAN JOAQU.IN COUNTY <br />pD��r <br />ii �,EDU ENVIRONMENTAL HEALTH DEP.ARTINEENT <br />'\304 E Weber Ave 3'1 door Stockton., CA 95205 <br />JUN 0 3 AT <br />468=3420 Fax: (209) 464-01.38 Web: www.co.san joaquin.ca.wdehd <br />END LOG NUMBER <br />460*7 <br />PHONE: 4:;?407 P 7-149 ®D (0 FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: QS On a 9 71me: <br />(Please allow 10 business days from date of application submittal') _M1.10lh e <br />/AanLf yd� <br />CHECK SOX TO EXPEDITE REQUES - S9 .00 FEE — REQUEST ROC ED IN 3 BUSINESS DAYS JAp <br />SIGNATURE OF APPLICANTA114 DATE <br />�l�r�� artmenl <br />• � - � �l1iL1l� �� <br />4®J�ag na2 y <br />reaA ... . <br />=_ 19 J <br />�•�: r-MRW. .' �'�+7i • %► illil1�11 J g '�.II!�IM11wr <br />0!i_rii'-%�Lr1U1tU111 <br />o. �mn �4y-aa-suwaa. a;;rJ eav � N7 e ■ 4cw'- <br />e. I — $ [004j Unit 5 Imm <br />to, srcnt 67 uST7?"14eif <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES r <br />UNDERGROUND YANK (UST) CLEANUP SITE (LOP) El HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONiTORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />nERED PERAQTTED FACILITY CI MOTELItiOTEL ❑ PUMPER' fRUCK/YARD/CHiEM TOILETS <br />❑ TATTOO/BODY PIERCING ❑ POOLISPA ><LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY 4 OTHER (PLEASE SPECIFY) _*6*40 <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. Fax to (209) 404-0138 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 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 EHD 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 />6. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. 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 />EMU -M <br />(m do pe+- 5a zalx-e i 1 wg1k7 <br />