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,rF <br /> C_I IV LVV IYVIVtOLI\ <br /> SAN J"OAQUIN COUNTY <br /> ENVIRO&M-ENTAL HEALTH DEPARTMENT <br /> - - 304 E Weber Avc 3rd Floor Stockton, CA 95205 <br /> <4v,j 468-3420 Fax: (209)464-0138 Web:www.co.sanjoaquin-ca.us/chd <br /> �yPUBLIC CaROS LLASE APPLrCATWN 0=PTI - <br /> APPLICANT: ZA BUSINESSIAGENCY: 6F6 <br /> ADDRESS: 2S'$4 N Te4cy &p;) t'14ff 3 F X61Y � Y5 3° 00� <br /> PHONE: 202• $35.40/0 FACSIMILE: 2a9' 6c�75 <br /> TENTATIVE"gPPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE RCOU1;ST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYSC�k <br /> SIGNATURE'OF APPLICANT A_4 1 �- DATE .1"4- <br /> `� <br /> Departrtient Use Only <br /> FILE ADDRESS UNIT <br /> / Unit 1 <br /> nl 2. GrP i7 5 <br /> us-, I a, svcc, OQqj,� CO,&10 cRy7GL / Unit 2 l <br /> u sr *t 1 •. sucec 2 S 4 Loo city 6 T PC 810,11 <br /> v 1P J)w city 74" craw / Unit 3 ,. <br /> V�+ us 6. Sreet d0tt O ,k76� <br /> T. SIM-1 Unit 4 <br /> A. Svect G <br /> 9. SVeet <br /> C Ljpit <br /> 10. S,rM <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> OUSING ABATEMENT OLID WASTE..- 1 <br /> NDER CLEANUP <br /> TANK(NON CLEANUP SITE(LOP)FOOD FACILITY �C,00 WASTE VEHICLE <br /> ATHER CLEANUP SITE(NON-LOP) �'' <br /> j�UNDERG ROUND TANK(MONITORINGIREMOVp.L) ;Rr3OG KENNEL OA1RY <br /> HAZARDOUS WASTE GENERATORHICKEN RANCH �KG TREATMENT PLANT <br /> ED PERMITTED FACILITY � TEUHO-EL / pUMpFR TRUCKTyARDlcHEM TOILETS <br /> TIERED ' �S tANo USE APPLICATION SITES <br /> El TATTOOIBODY PIERCING <br /> Po' <br /> MEDICAL WASTE FACILITY Q OTHER(PLEASE SPECIF1n <br /> 9. 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)464-0938 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 hold 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 /> 5. *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 /> EHD I8-02-005 <br /> A/W�001 ' <br />