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01/14/2005 09:46 FA 209 9480 _ Q 002/002 <br /> REcrzIVEo SAN JOAQUIN COUNTY <br /> C�CO�ICD <br /> EN=ONMNTALRFALTHDEPARTMNT •.' <br /> 304 E Weber Avc 3'd Floor Stockton;CA 95205 <br /> .' 1 ORA468-3420 Fax:(209)464-0138 Web:Vw".co.saa joaquimmus/chd <br /> ENVIRONMENT HEALTH PUBLIC RECO"S ��,EASE AppLICA.'I o <br /> APPLIC/wr: N4+-- .fa BUSINESSIAGENCY: � <br /> ADMeSS: a - lkyf-il;, `. .�- 'E�io,� tu► <br /> PHONE:_ _� �3FtS' FACSIMILE: 9wg o'L�• - " <br /> TENTATW APPOINTMENT DATE Tkne• 21.00 <br /> gnome allow 10 business days from date of appilmdon subm" <br /> CHECK BOX TO EXPEDITE REQUEST-193.00 FIEF,REQUEST PROCESSED IN 3 BUSINESS DAYS , <br /> SiGNATURE OF APPLICANT DATE 1 14104571 <br /> Dep rtrnent Uaa only <br /> F LE ADDRESS UNIT <br /> ,. m p " Unit 1 <br /> 121Vit A), F1 F. Unit 2 �,�A <br /> P <br /> "e- <br /> je Unit 4 <br /> L sweet C* <br /> IL RZ Unit 5 <br /> •EPMRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(VST)CLEANUP 3"(LOP) ❑ HOUSiNG ABATEMENT iii.zoi w W <br /> p FOOD FAC0.ITY 0 SOUO WASTE VEHICLE <br /> OTHER CLEANUP Stili(HON-LOP) <br /> IM UNDERGROUND TANK(MONITORINGiREMOVAL) p DOQ 1111"04 M DAIRY <br /> m HAZAA06US WASTE GENERATOR M CHIC99H RANCH iE-PKG yMATIABNT PLANT <br /> (3 TIERED PERMi'(TED FACILITY 0 MOTELiHOTEL O PUMPER TRUCKiYARX)fcWM TOR.E'TS <br /> ❑ TATTOOi800Y PIERCING ❑ POOLiSPA la LAND U$E APPLICATION SM <br /> ❑ MEDICAL WASTE FACILITY d OTHER(PLEASE SPEC <br /> 1. List up to ten addresses in the space above. Select the type(s)of tiles from the list aboys oy checking <br /> the appropriate box(es). At least one file type MUST be selected. Em to(2M 464-0130.or mail to <br /> the <br /> addresz Indicated above. <br /> 2. EHO will notify the applic int 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 retumed in the same condition as released will be reorganized by EHD start 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 wilt be processed the next business day. <br /> • �+1, AM <br /> Fs•D ••:— ->•TIIiAE .'s".'' =s..A S ss �a.3tl ~`' t.. . <br /> Arl: V6 <br /> ! A�TEONFIft14�l=D FARC"; ', �;ti;.t [1Fjglg' _. ._...;c,' •:�. <br /> . <br /> FtEV(EVNED ,. YES NO REVIEW DATE•; "' <br />