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r�icvud uu:-37 FAX 209 9480621 <br /> 0) �,y J - 0003/004 <br /> FAA <br /> Y�1 } `L� <br /> '��'`-•�`�''1 'IUSAN JOAQUIN COUNTYP BL � <br /> U IC HEALTH SERVICES EM LOG NUMBER <br /> SEP 1.7 2003 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ENVIRONMENT HEALTH sTOCKTON CA 95202 <br /> PERMIT/SERVICES PUBLIC RECORDS I)468-3420 <br /> PE EASE APPLI T <br /> CA lON <br /> APPLICANT � BUSINESSIAGENCY_ <br /> AD DR1:55 �'1C.-.1�)��3 � ��-�-C•7 �' <br /> PHONE FACSIMILE_?-Or-7 <br /> TENTATIVE"APPOINTMENT DATE_ / /Z.4'/t Time <br /> (Please give 7 to 10 buhine=days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST.$87.00 FEE- <br /> QUEST PROC>=SSE BUSINESS BUSESS DAYS <br /> SIGNATURE OF APPLICANT DATE O <br /> FILE ADDRE$$ THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 3 <br /> the Nw 9 S-,bk=, <br /> R.o <br /> Sob N. wtt_ <br /> /bL <br /> L t 1 <br /> -dFr/MAI <br /> ENVIRONMENTAL HEALTH DIVISION FILES U� <br /> Pt UNDERGROUND TANK(UST)CLEANUP SITE(LOP) n HOUSING ABATEMENT W SOLID WASTE FACILITY <br /> IP*OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FAC[LITY ❑ SOLID WASTE VEHICLE <br /> 9t UNDERGROUND TANK(MONITORINGtREMOVAL) ❑ DOG KENNEL M DAIRY <br /> 01 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 93 PKG TREATMENT PLANT <br /> CI TIERED PERMITTED FACILnY ❑ MOTELlHOTEL ❑ PUMPER TRUCKlYARDICHEM TOILETS <br /> C3 TATTOOJBODY PEIRCING ❑•PdGL%SPA 19'LAND USE APPLICATION SITES <br /> CI MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <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)464-0138 or mall 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$87.00 deposit prior to review. <br /> b• '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 /> REMEVYED YES NO REVIEW DATE . <br />