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FROM Geo-Phase Environment-_ Inc. FAX N0. 2795690295 Jul. 12 2005 11:07AN P2 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN R AQi1IN COUNTY <br /> nECENED ENVfRONMENTA L H EALTH DEPARTMENT <br /> 1 304 E Weber Ave 3Td Floor Stockton, CA 95205 <br /> JUL j2�9G � -3420 Fax: (209)464-01'18 W,!b: www.co,san-joaquin.ca.us/ehd <br /> ENT HEAMLIC RECORD 3 Rf:LEASE APPLICATION <br /> EW F <br /> APPLICANT: o:�A-Cl BUSH ESSIA-3ENCY: <br /> t51-7 <br /> ADDRESS: 5� elle P-4-,dna <br /> PHONE: FACS MILE, : 7 <br /> TENTATIVE`APPOINTMENT DATE; �'r Tlmo: <br /> (Please allow 10 businov+days rom date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUESY-593.00 FEE-RE()JEST DROCESSED IN 3 BU ESS DAYS <br /> SIGNATURE OF APPLICANT ��/ DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> ,. street !' 45o✓r`vr 414cit, �- `] D ' ❑ Unit 1 ll <br /> 2. Street Kf /r dk/ V at, �� �;`✓� " <br /> 3. Street i <br /> E] Unit Z <br /> ,. street >� <br /> j` ' ,, <br /> I- <br /> f., 6veac 6d Unit 3 �( <br /> 7. Sheat at/ Unit <br /> 4 <br /> 6. Street <br /> a_ Street ❑ Unit 5 <br /> greet <br /> ,y ENelN(i <br /> EALTH DEPARTMENT FILES <br /> p <br /> UNDERGROUND1 (U?S ANUP ABATEMENT <br /> ❑ SOLID WASTE FACILITY <br /> Ck'OTHER CLEANUP SHEvo `: OP) FFCILIIY ❑ SOUD WASTE VEHICLE <br /> O UNDERGROUND TANK(MO ORINGIRKENNEL ❑ DAIRY <br /> * HAXARDOVS WASTE GENERATOR o Ci IICKEl, RANCH C7 PKG TREATMENT PLANT <br /> ❑ TIERED.PERMMED FACILITY C1 M)TELA OTEL ❑ PUMPERTRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ Pt)OL15F A C] LAND USE APPLICATION SrfES <br /> ❑ MEDICAL WASTE FACILITY ❑ O ITER('JLEASE SPECIFY) <br /> 1. List up to ten addresses in the space ab )ve. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one filE type MUST be selected. Fax to(209)464-0138 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 Inc later than ten (10)days after receipt of application. The files <br /> will be held for a maximum of five busin :ss d;tys 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-He is available. <br /> 4. Any file not returned in the same conditi,)n as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by t ne sane applicant may require a$93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must b( conf rmed with EHD staff. <br /> 6. Applications received after 3:00 pm will )e processed the next business day. <br /> CONFIRMED APPOINTMENT DATE.: TIME. <br /> DATE CONFIRMED PHONE FAX INITIALS _ <br /> REVIEWED YES NO REVIEW DATE <br /> END 48-02.006 <br /> 9/8r20Q3 <br />