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--- 05-30-7LeQo 10 yPo'1 FRO•` TO 461 ._ <br /> Iµi.'t'i ILLCr;tvky V � El <br /> j SAN JOAQUIN COUNTVPUSLIC HEALTH SERVICES <br /> I ENVIRONMENTAL HEALTH DIVISION 1 2 4 2 00 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 ENVIRONMENT HEALTH <br /> PUBLICRECORDS RELF-ASE APPLICATION PERMIT/SERVICES <br /> iAPPUCAN7 VL .,^Y 5 INESS1AQENCY <br /> i <br /> �ADPRESS <br /> ;PHONE ' L 014Q C) FACSLVlLR 1 <br /> TENTATIVE*APPOINTMENT DATE '"ME { <br /> (Yleasv¢lye 7 to IQ business days from date of application subtnfuaq <br /> CHECK BOX TO EXPEDn E REQUEST- 8 uo FEE-REQUEST 11 CE3 ES=NESS DAYS ` <br /> SIGNATURE OF APPLICANT DATE <br /> i <br /> FILE ADDRESS THIS SIDE EHD STAFF U66 ONLY <br /> PROGRAM ELFMFXTS: EAWH <br /> t- c] -' Q <br /> i <br /> I <br /> i <br /> I <br /> ENVIRONMENTAL HEALTH 131VISIONI FILES <br /> I-UNDERGROUND TAKK(UST)CLEANuP s1TE(LOP) 0 HAUSIXG ABATEMEn ❑ SOLID WASTE FACILAY <br /> arHER CLF-ANIJP Sri [NON-1-OP) D FOOD FA=ITY A SCUD WASTEvElllcLl; <br /> UNDERGROUND TANK(M0NITOEuNGIREm0VAL) O DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHW4(em RANCH ❑ P'KG TREATMENT PLANT <br /> O TIERED PERMITTER PACLLITY ❑ MOTWHOTEL D PUMPER Z$.UCKNARD=ZM T0I1.9TS <br /> 4 TATTOOIgODY PEIRCING ❑ PooLispA ❑ LAND USE APPL1CA'iION SrrE <br /> k7 MEDICAL wASYe FACILITY ❑ PUBLIC VVATER SYSTEM O OTAtR(PLEASF SPECIFY ABOVE) <br /> I <br /> 'i. 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 fie type MUST be selected. Fax to 09 464 1 8 or ma')to the <br /> i address indiftated above. <br /> 2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirMed <br /> approximately five business Mays but no later than ten(10)days after receipt of application_ 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 on by EHD staff May not be immediately available for review. A new <br /> application may be submitted when the flie iS avaiiable. <br /> 4- Any fele not returned in the saMe condition as released Will be reoreanired by FHD staff at the expense <br /> i of the applicant Future file reviews by the same applicant may requlra a $78.00 deppsit prior to review,. <br /> S. "TENTATIVE appointment dates must be confirmed with EHL)staff. <br /> 6. Applications received after 3;00 pm will be processed the next business day. <br /> i <br /> ONIFIRMED APPOINTMENT DATE TIME <br /> ATE CONFIRMED PHONE FAX INITIALS <br /> VIEWED YES NO REVIEW DATE -� <br /> TOTAL P.01 <br />