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FROM : Geo-Phase EnvironmentilwAinc. FAX NO, 2795690295 .Jai. 12 2005 11:07AM P2 ti <br /> DATE RECEIVED EHO LOG NVM13Ek <br /> SAN R AQIIN COUNTY <br /> HEC"'E3 V ED ENYIRONMENTA.HEALTH DEPARTMENT, <br /> 304 E Weber Ave 3 Floor Stockton- CA 95205 <br /> =3420 Fax: (209)464-0138 W.-.b: www.co.sanyoaquimca:uslehd p <br /> JUL 2 f�ffl <br /> ENT HEA4R�B . C RECORD 3 NZEASE APPLICATION :: : i,: <br /> APPLICANT,PE <br /> 44! <br /> L <br /> ADDRESS: �! Z C�+r4"-In gzdo_ <br /> PRONE: FAGS MILE: r ii <br /> TENTATIVE:APPOINTMENT DATE; Time: - _- <br /> (Please allow 10 buslnes:;days,torn"date of appllcatlon submittal} <br /> CHECK SOX TO EXPEDITE REQUEST-$93.00 FEEC-RE ")JEST 3ROCESSED IN 3 BIJ ESS PAYS <br /> SIGNATURE OF APPLICANT �/ �" '�s DATE, <br /> Oepe tment Use Only <br /> FILE ADDRESS t!. UNIT <br /> �. street G4orr�r <itlQ alt, �1 O [] : Unit 1 ZLLS`1 <br /> i t Ae <br /> 3. street rte7'tRY I1 ---Td�R G AJ-Pi <br /> unr'y� /� <br /> lt2 L <br /> 4. svaet 7 75- / �"'° <br /> � <br /> I 0"'t 17'021 -4411ef'A � jib 1.jn3 <br /> t. streat Aft <br /> 0` Unit 4 x <br /> 8. seem <br /> e. street 0 " Unit 5 <br /> get <br /> ENVI EAL.TM DEPARTMENT FILES <br /> XUNDERGROUND ANUP Hi iuslw,ABATEMENT ❑ SOLID WAS'T'E FACILITY, <br /> WOTHER CLEANUP SITE O P) ❑ FOOD FPCILIfY ❑ SOLID WASTE VEHICLE a <br /> ID UNDERGROUND TANK(MO ORINGIRE AL} LT Dt G KEIINEL ❑ DAIRY ^ 41 <br /> ❑ HAZARDOUS WASTE GENERATOR 11 cl acKI_r RANCH " ❑ PKG TREATMENT PLANT <br /> © TiERED.PERMI7TI=D FACILITY p M)TELlt'OTEL C3 PUMPER TfiUC jYARD/OHF-M TOILETS <br /> 13 TATTOO/BODY PIERCING ❑ Pt IOUSF A ❑ LAND USE APPLICATION STYES <br /> 11 MEEDIM WASTE FACILITY ❑ OY TIER(2LE:ASEE SPECIFY] <br /> " X11 <br /> 1. Last up to ten addresses In the space ab,Ive. Select the types)of files from the Ii$t;Aboye by checking <br /> fhe appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0738 dr mail to the <br /> address Indicatedabove. <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 applicatign. The files <br /> will be held for a maximum of five basin ass days for review. Appointments shouldlbe scheduled <br /> accordingly. <br /> 3. A file that is actively Tieing worked on b) EHD staff may not be immediately avai[able for review. A new <br /> application may be submitted when the•Ile is available. <br /> 4. Any file not returned in the same eonditi on as released will be'reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by t he same applicant may require a$93.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must bt conf•rmed with fEHD staff. - h <br /> G. Applications received after 3:00 pm will ie pr<Icessed the next business day. <br /> CC] !FIRMED APPOINTMENT DATI+ ; <br /> TIME. <br /> DATE CONFIRMED 'PTfONt FAX-' . INIT ALS.: � <br /> REVIEWED YES 'No, REVIEW.DATE <br /> 04044-02:606 - <br /> NB OW <br /> h <br />