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�qw�ej!411� ti/j��iP$ 209-579-2225 <br /> r MQDESTO ATC _PAGE 01 .. <br /> SAN:JOA l 1EMP LOG NUMBER <br /> qU N COUNTY <br /> SEP 0 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 <br /> EAST wt:S <br /> l:R ava=NUE <br /> .THIRD FLOOR <br /> _N}J; uWENT HEALTH :STOCKTON CA 95202 <br /> PFP)[0! %SERVICES {209)468 420 . .. I q <br /> PUBLIC RECORDS R <br /> E <br /> LEA <br /> S <br /> E <br /> AP • <br /> PLICATION <br /> APPLICANT Qtr BUSINESSIAGENCY <br /> jih <br /> ADDRESS MIL <br /> PHONE Z FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE TIME d4 ccl <br /> (Pisaas glue 7'0 10 business days from date of application eubmlttal) s <br /> . <br /> CHECK BOX TO EXPEOFTE REQUEST•$88.00 F E-REQUEST PROCESSED IN.3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � y <br /> DATE <br /> FILE ADDRESS THM SIDE EP5 STAFF USE ONLY <br /> Z3� <br /> PROGRAM ELEMENTS SEARCH ' <br /> a <br /> 3 o d N14l coy <br /> L� S�•r-1-o-, f <br /> ZLQ\ l.�od fives ,3' n <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> i V UNDERGROUND TANK NST)CLEANUP SITE(LOP) 0 HOUSINGS ABATEMENT ❑ SOLID WASTE FACILrTY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> } ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) O D6G KENNEL. ❑ DAIRY <br /> © HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ -PUMPER TRUCKIYARD/CHEM TOILETS <br /> TATTOOIBODY PEIRCING ❑ PbOLISPA 13 LAND USE APPLICATION SITES ! <br /> 0 MEDICAL WASTE FACILII•Y0 OTHER(PLEASE$PECiFn <br /> 1. List up to ten addresses In the space above. Select the type(s)of flies from the list above by checkln' j <br /> the appropriate bax(es). At least one flle'type MUST be selected: Fox t 4 4114-0138 of Mail to the <br /> addrels Indicatesdi a4ove. <br /> 2• EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10)days after receipt of application. The files <br /> will be held for a maximum of five bus[ness days 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 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 flle reviews by the Same applicant may require a$89.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> s• Applications received after 3:00 pm will be processed the next business day. , <br /> I ' RPC>llQTlhl CtA1'E Titi t <br /> DATe <br /> PHONE <br /> .R> lb YES NO Il�liK 1� E. <br />