Laserfiche WebLink
•--- ..vv V40VOZI ` <br /> i�iG02/002 <br /> DATE RECEN1r0 � � j� , . .. . » <br /> f SAN JC A <br /> QtTN COUMT <br /> RCOVED ENVIRON-MENTA LHEALTU DEPARrMFr T <br /> 04 E Weber Ave 3 Float Stockton,CA 95205 <br /> JUL I M968-3420 Fai: (209)464-01A VY-:b:wnvw-co.saa joagiiia.ca.us/chd 79Z <br /> pp�� 1 H1ALR1PU LYC RECORD;, ULEASE.APPLICATION <br /> 7,0" <br /> UAl�I`;'� E �'a5 <br /> I✓7 „SUSLN ESSIA 3ENCY. <br /> AAORESS: A s <br /> _ 9 , <br /> PHONE: FA=MILE: <br /> TENTATIVE;APPOfNTMENT DATE: <br /> +0 ? <br /> Tme• ( o <br /> (Please 211UW 10 buSjft." days from state of appli(a on aubmittao <br /> f ® CHECK BOX TO ExpEDITE REQUEST•483.00 FEE,REC UEST iAROCEssED IN 3 SUSINESS DAys <br /> SIGNATURE OF APPLICANT RATE ? _ <br /> T C3 0 dfinent Use 0* f <br /> PILE ADDRESS UN(T <br /> ,La <br /> -_- <br /> L sulw bb-1 R ^� r 0 Unit 1 <br /> a. s Cl <br /> <. ., GUnit Z <br /> T. Sired <br /> Cir, <br /> 1 <br /> -- <br /> ta. Shed CA{ Unit 5 <br /> �I <br /> •ENV'IRONMENTAI,HEALTH DEPARTMENT FILES <br /> UIHDERGAOuNO TAJ K(us-n CLEANUP arLE(LQP) in H(suszN(c AEAIr_mEHT Oil,z3OLi0 WASTE FACiLFiY <br /> OTHER CLEANUP SITS{NON LOP) ❑ FC 400 FA CIL" IM SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(mowrofuNGlFiamoyAg ❑ w(G KElINEL 99L bAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CI IICKEY;RANCH 1iLP%n YREATMF_NT PLANT <br /> ❑ TIERED PERMITTED FACiLr(Y In W)TEL4.QTtL- La FumpeR TRUCKfYARD1Giem ToiLETS <br /> d TAT-rooiaocY PIERCING CI P(K3LrSF A tS LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILrrY, 0 O"TIER($LEASE SPECIFY}- � <br /> 1. List up to tern addresses In the.space ab we. ,Wect the type(s)of files from the list aboya by checking <br /> the appropriate box(es). At least one Fite type MUST be selected, Fax to(209146.4-0138 or mail to the <br /> address indicated above. <br /> 2. EHQ will notify the alppiiCAnt if any EHO•iles a Ast. An appointment for review will be confirmed <br /> approximately Cye business days but nc later than ten (10) days alter receipt of application. The files <br /> Will be held for a maximum of rive busin:ss d Lys for review, Appaintments should be scheduled <br /> accordingly, <br /> — ,3= A r4Ie_thatA3,_aCtjve "n- i--EH sfiaff ymotim-immediately-avail�le4cf-reWeW.A new. <br /> application may be submitted when the •Ile is available. <br /> 4. Any file not returned in the same candid on as released will be reorganized by EHD staff at the expense <br /> of the;appiicant, Future fife reviews by 1 he same applicant may require a $93.00 deposit prior to review <br /> S, *TENTATIVE appointment dates must b(: confirmed with EHD staff. <br /> fi. Applications received after 3:00 pm will be pricessed the next business day. <br /> wONFAF��F�131��F.'..POiNTMENT'IjA7E'�:.Y Y'TIME <br /> DATE CON FiI k90 _ -?PHONE FAX-- L- INI" ALS <br /> .REVIEWED I ,; YES NO REVIEW DATE; ' <br />