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nn <br /> -i. <br /> 190021002 <br /> SAN JOA,Qv7N COUNTY � cn..L� " <br /> wn�w, <br /> t <br /> `' 2NVrRONITIENTAL HEAZ Ti M DuAp TMENT <br /> (706 304 E Weber Ave ' <br /> ` , - ��,Q?}�468-3420 Fax; (209)464-0138 �Floor Stockton, CA 95205 <br /> E NVI?-i0N,,t' �I� <br /> WWW.00.5$II J03qI11D.CS.1,L5/e11d � osso <br /> f PEf�3;"�1,����'�JIG�S <br /> i PUBLxC CORDS �LEASE AFFLYCATTON <br /> APPLICANT. ` BUSINESSIAGENCY. <br /> ADDRESS: <br /> f� <br /> PIiQNE: — L FACSIMILE, — OCooZI <br /> TENTATIVE,APPow HENT DATE. 1 •xo ' <br /> (PIease allow 10 busfnass days from date of application subenittal) <br /> C] CHECK BOX TO EXPEDITE REQUEST-$93.00 FU—REQUEST PROCESSED IN 3 BUSINE55 DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> t]aparhmnt Use OW <br /> FILE ADDRESS t1t1fT <br /> «- <br /> =cy <br /> :. AX ❑ Unit 1 <br /> a sen.e� �O 1 <br /> 4. aY..i u Unit 2 ' <br /> Ckyt <br /> a. scars r�drdf ' �, Unit 3 <br /> ,! s� <br /> sa. area a p Unit 5 <br /> Or <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ja (0, <br /> UKDeRGROUNO TAMC(UST)CLEAIIUA SITE(LOP) 0 HOUSING ABATEMENT OL souo WASTE FACILM. <br /> OTHER CLEANUP SITS(NON-Lop) 17 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> >� UNDERGROUND TANK(MONfI ORIN%%EMOVAL) ❑ DOG KERNEL 15�.DAIRY <br /> t{AZARDOUS WASTE GENERATOR 0 CHICKEN RANCH W PKG TREATMENT PLANT <br /> D TIERED PERSArMD FACILITY O MO'MLIHOTEL ❑ PUMPER TRUCIVYARDICHEM TOILETS <br /> ❑ TATT00I300Y PIERCING Q POOLISPA ISL LANG USE APPLICATION SnE5 <br /> 0 MEDICAL WASTE FAC[Lrrf Q OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list aboye ny checking <br /> the appropriate box(eS). At least one file type MUST be selected. Fax to(209)4.6:4_-0138 or mail to the <br /> address indicated above. <br /> 2 I;HO 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 business 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 ratumed 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 $93.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EMD staff. <br /> 6. Applications received after 3:00 pm wilt be processed the next business day. <br /> CQOIR-M50J.0'alNTN1ENT ATI ~' _`�: =; :' , RIME <br /> DATE GdNFI. . �D ;y,,-. <br /> RM PHONE FAX'" '""INITIALS •�::= <br /> REVIEWED __ YES NO REVIEW BATE ' <br /> RHO 44-02-00% <br />