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DEC-13-2004 12 53 ^`ODOR EARTH TECH 209 532 0773 P.01i0: <br /> PATE RECEIVED __ ._ • EHD LOG NUN <br /> [���i c _ I SAN JOAQUIN COUNTY <br /> T IPRNVm0mmycAL H aTH DFrARTmmNT <br /> DEC 1 ;3 2004 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209) 464-0138 Web: vzWW.c0,sau joa�quin.ca.us/ehd <br /> HIJ,_,h <br /> PE I:[,! 1]VICES P1UBLIC ' A CORDS RE,LEASE APPLICATION <br /> AFFUCANT: A-rs J ( y[ZJ Z,1Kr_ • 6USIXESS1AGENCY: L-d �> 1Z &Wlu t� S <br /> ADDRESS: <br /> P H 0 N ., �_ — _ FACSIMILE: <br /> TENTATIVE'APPOIHTAAENT DATE: _LlP�em f=sef me:_ 0 A A— <br /> (Please allow I buslnaas days from date of appilratlon submlttan <br /> 29- CHECK BOX To Exprm m T-S93.Q0 FEE--REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE J3 <br /> Departrne it Use Only <br /> FILE ADDRESS I UNIT <br /> 2- iSb*o <br /> t 9: 1 3'4 5 1 Mya 1 �-- Unit 2 1� <br /> �? <br /> s. so-eet 4My Unit 3 " <br /> ur <br /> lPf" &rte a aty4 <br /> 6 as <br /> STOn4CI-6tJ MBIE�azJAM Al ISE 500D <br /> Unit<4 <br /> Gir(11t Sr Ir <br /> 10. sew , <br /> UUAA <br /> E=NVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP srTE(LOP) 0 HOUSING A13ATEMENT SOLID WASTE F <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FAmLITY SOLI)WASTE E <br /> UNDERGROUND TANK(MON1ToRjNG/REmOYAL) ❑ DOG KENNEL .b'DAIRY <br /> �¢ HAZARDOUS WASTE GENERATOR CHICKEN RANCH b PKG TREATMENT PLANT <br /> TIET�ED PERMITTED FACILITY Q MOTELIHOTTBL I7 PUMPER TRUCK/YARDICHE M T0U_E7S <br /> G TATTOO/EOpY PIERCING O POOLISPA LAND USE APPLICATION SITES <br /> J? MEDICAL WASTE FACILITY ❑ OTHER(PLEASE 3PEGIFY) _ <br /> 1. List up to ten addresses in the space above_ Select the type(s)of files from the list above by checklnl <br /> the appropttate box(es). At least one file type MUST he selected. Fax to(209) 46"138 or mail to the <br /> address Indicated above. <br /> 2. I~HD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no laxer 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 lie scheduled <br /> accordingly. . <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A no, <br /> application may be submitted when the file Is available. <br /> 4. Any fle not returned in the same condition as roleased will be reorganized by EHO stuff at the expens <br /> of the applicant. Future file reviews by the same applicant may require a$93-00 deposit prior to raviel <br /> 5. *TENTATIVE appointment dates roust be confirmed wlth EHD staff, <br /> 6. Applications received after 3:00 pro will be processed the next business day <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DINE CONFIRMED 'PHONE - FAX INITIALS'-. <br /> REVIEWED .- YES NO REMEW DATE <br /> TOTAL P.O: <br />