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03/25/2004 17:49 4159899934 ENVEF PAGE 01 <br /> 39�FIVW E.V, SAN JoAQuiN C( LINTY <br /> MAR•2 6 2004 ENVIRONMENTAL HEALTI I DEPARTMENT <br /> 304 E Weber Ave 3`1 Floor Sto kton, CA 95205 q7 <br /> FIVIRONMENT H4800468-3420 Fax: (209)464-0138 Web: wwv.co,.san-Joaqujn.ca.us/ebd 17 <br /> PERM TISERVICES <br /> PUBLIC RECO"S BELE E"PLICATION <br /> APPLICANT; t- w EU51NESSIAGENCY: e <br /> ADDRESS: � "l `n OI r ✓!/r ' f �-CO <br /> PHONE:_ 15) 614153 C 4�3 FACSIMILE: 1 q- [ [ 3 <br /> TENTATIVE*AF'F'UINIMLNI VAIs: n �) Time: <br /> (Please allow 90 business days from data 5f applkatlon submittal) <br /> CHECK SOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESS DIN 1 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Y i"�^ DATE <br /> v epartment Use Only <br /> FILE ADDRESS UNIT <br /> P viv nit t <br /> 2. t m ec-hp Lt4A u <br /> 3 D - 1Unit 2 <br /> a. e$ W c `+ Unit 3 <br /> r� 1 <br /> 6. of CRY C-1 d <br /> r. ter., l 1A rn cn 'Unit <br /> e D r c <br /> 1 4eq�fA Ai S ❑ Unit 5 <br /> ENVIRONMENTAL HEALTH DE ARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A5ATE_M0T. Cl SOLID WASTE FACILITY <br /> M OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 S0010 WASTE VEHICLE <br /> a UNDERGROUND TANK(NIOMTORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> ❑ HAZARDOUS WASTE GIENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> O TATTOQIeoDY PIERCING 0 POOU*PA 0 LAND ME APPLICATION SUES <br /> C3 MEDICAL wASTE FACILITY 0 OTHER(PLEASESPECIFY) <br /> 1. list up to ten addresses in the space above. Select the type(s)of files from the Ilst above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(20 9)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHO will notify the applioant if any EHD files oxist. An oppointment for review will hp 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 FHD 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 start at the expense <br /> of the applicant. Future file reviews by the same 2ppliC ant may require a$93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME: <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DA-M <br /> EHD 46-02-M <br /> WM3 <br />