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FROM Geo--Phase Envfronmenta:Inc. FAX NO 2795690295 � � Jul. 12 2005 11:07AM P2 <br /> I� r <br /> ^ DA75,RECEIVED EHO LOG NUM$Ek I <br /> SAN KAQUIN COUNTY <br /> RECENED <br /> ENVIRONMENTA L H EALTH DEPARTMENT <br /> gg 304 H Weber Ave P Floor Stockton ICA 95205 <br /> JUL 12%9�ffl.3420 Fax: (209)464-01:18 W.!b:www.co.san jaaquin.ca.us/ehd <br /> f <br /> EfVT HEA�IUBLIC RECORD 3 W.LEASE APPLICAMN <br /> MRVIULb <br /> APPLICANT J" SUSIh ESSlA3ENCY:. /:��q ! ' c-/r 7- +!-ta,�7 � <br /> F <br /> ADDRESS: <br /> PHONE:. aw 913 FACS MILE: <br /> 9 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please atiow i0 business;days`Tom date of application submittal) <br /> •j I <br /> CHECK SOX TO EXPEDITE REQUEST-$93'00 FEE—RE NEST PROCESSED IN 3,IBU ESS PAYS 4 <br /> SIGNATURE OF APPLICANT--40Z!0001 ./ � ' DATE <br /> lC Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. steel G4eAireo. Cif ' S <br /> z. sweet k� Iffy �f en, �r [� Unit 1 f�LL y� i <br /> �' <br /> s. street .�'•u7'Ntr' t/ � e-V •F:� - Q Unit 2 3 , <br /> +� e y3 I <br /> 4. BtroeS 5'5— � �� '" 4 i <br /> a�. 4 . <br /> --�- --� �nit <br /> 5. Stmt <br /> 8. Sgeet : <br /> e sweet Adat 0 Unit 6 � <br /> e: N <br /> ENVI EALTH DEPARTME=NT FILMS k <br /> XUNDERGROU 0 ( ANUP HI IUSINC,ABATEMENT ` ❑ SOLID WASTE FACILITY p <br /> WOTHER CLEANUP SITE O P) ❑ FOOD FF CILITY 13 SOUO WASTE VEHICLE <br /> O UNDERGROUND TANK(MO ORINGIRI M AL] ❑ DOG KEI INEL ❑ DAIRY f <br /> Q HAZARDOUS WASTE GENERATOR' ❑ CI IICICHP;RANCH '� ❑ PKG TREATMENT PLANT <br /> 0 TIERED.PERMITTED FACILITY ❑ M)TEUVOTEL it 0 PUMPER TRUCK)YARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING 0 Pt*USF A G ❑ LAND USE APPLICATION SrMS { <br /> ❑ MEDICAL WASTE FACILITY 17 EY TIER(2LEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. 'Pelect the type($)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2b9 464-0'138 or mail to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant if any EHD'Iles exist. An appointment for review will be confirmed <br /> approximately five business days but nc later than ten(10)days.after receipt of application. The files <br /> will be held for a maximum of five burin:as drys for review.;Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on b) EHD staff may not be immediately available for review. A new : <br /> application may be submitted when the'ile 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 t he sa ne applicant may require a$53.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must bt conf-rmod with EHD staff. k <br /> 6. Applications received after 3:00 pm will 3e processed the next business day. <br /> CONFIRMED APPOINTMENT DATE ..... TIME. - - <br /> � .: ::.. .... : . : .. <br /> DATE CaNFIRMED 'Pl10Nt FAX-' . INITIALS <br /> REVIEWED YES NO REVIEW BATE <br /> E140411-02-006 „ <br />