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va/ UOU4 fur. ul:ur FAX 415 892 9475 PES ENVIRONMENTAL <br /> Q 0 01 <br /> b8/30/2002 15:34 2083433 FIFTH FLOOR PAGE 02 <br /> SAN JOAQUIN COUNTYPUBLIC • <br /> - HEALTH SERVI H <br /> ENVIRONMENTAL HEALTH DrVislo <br /> � <br /> w 304 EAST WEBER AVENUE,THIRD F 00R nCDn <br /> STOCKTON CA 95202 <br /> PUBLIC RECORDS 468-3420 <br /> EASE APPLICATION <br /> SEP 0 3 2002 <br /> APPLICANT. sq-c. C',e1zM,4,.-Ihs BUSIMSSlAGENCY Pc-,% I, ONn��N7�NV1VWj) NTENT HEALTH <br /> ADDRESS (�°�2- T1ov�To QISJQ1-re- foo r(ov'.^►'o <br /> PHONE 41j- I Cn o o PAt�STM1lE �L l S $ `I 9 . <br /> TENTATIVE".APPOINTMENT DATE 9/ 1-4/ o-4- <br /> (Please <br /> / 12/ oZ(Please give Ip Wit ice da rom f appllcE submittal) M <br /> CHECK SOX TO EXPEDITE <br /> REQUEST.X89.00 Et~-R1;QUEST PROCESSED 9 I3 INESS DAYS <br /> SIGNATURE OF APPLICANT DATE $ / 30/o-2- <br /> FILE <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 5 . A10. oL wti s'f'o tkT <br /> -2.C.61 S. hIRP0RT �.+q - ot/TocK`rtH <br /> 32-HIL S . GL <br /> 7-'7v0 S, ch�-1 FoRI11 S^, actcrarl <br /> 2So 5. EL D <br /> Zyp2 <br /> S . c1%L11=a0r+�h s'R2d`-r s7'ock-�r-a.l n ^J11-1 <br /> 3►0� r. eL p-aR oo s-riz�a 4Toc IcYor{ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> NDER <br /> GROUND TANK(UST)CLEANUP SITE(LOP) D 14OUSINI3 ABATEMENT 4 SOLID WASTE FACILITY <br /> OTHER CLEANUP SrM(NON-LOT) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNET. ❑ DAIRY <br /> �HAMUOU9 WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT \\ <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELIHO'TEL ❑ PUMPER TRUCKIYARDICHI=M TOILETS <br /> ❑ MEDICALTATTOOIWAS Pt ARCING 4 POOUfSPA ❑ LAND USE!APPLICATION SITES <br /> O MEDICAL WASTE FACILITY d PUBLIC WATER SYSTEM O 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)464-013j or mail to the <br /> address Indi ted a ve. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment <br /> irmed <br /> approximatcly five business days but no later than ten(1days after receipt of application.ol be fn. The files <br /> will be held for a maximum of five business clays for review, Appointments should be scheduled <br /> accordingly. <br /> 3. A file that-is actively being worked an by EHD staff may not be immediately available for review. A new <br /> application may be submitted when tho 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$89.00 deposit prior to review. <br /> S. <br /> *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 <br /> ����_ YES NO REVIEW DATE <br />