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Shin LOG WUM,RFfi <br /> i".,,ns EIVEl7 SAN,T6AQU1N CO'UNTY *7 <br /> A =1T Dy-PA.RT1V)` NT \ IL <br /> 344 E Weber A.va 3 Floor Stockton, CA 95205 25" <br /> APR 2, 7 2066(209) 468-3420 'Fax: (219) 464-013 8 Web: wwtiv.Co.sa;a-)oaqukp.ca.uslehd <br /> ENV;RONNIEN i HEALTH YU13LIC RECO IRDS �L,EA.SE APPLICATIONP� , <br /> APPLICANT! A-i <br /> sUSINESSfAGENCY: <br /> ADDRESS: "k{� ..12if� <br /> PHONE: ' c� A�'J * FACSIMII- : <br /> TENTATIVE*APPOINTMENT DATE:� 0� Tirze: <br /> (Please allow 1 U bt,Ltiiness days from date of apptitation submittal) <br /> CH>rCK SRX TO T=XPEDiT_REQUEST-$93.00 FEE~REQUEST PROCESSED SN 3 BUSINESS DAYS ��r� r- <br /> DATE y, <br /> SIGNATURE OF APPLICANT. pepartmcnt Use only <br /> UNIT <br /> FMX ADDRESS. <br /> � �Gl� _ ❑ unit 1 <br /> 1. Ertel . <br /> Gly. exZT", <br /> 3. S1reeL `i U6� ✓ <br /> CIL <br /> Unit.x. <br /> Ci[Y <br /> 5. $trret <br /> 'K, Streel <br /> �`- <br /> e. Strr:et - Cb ❑ Unit 5 <br /> a, streei <br /> 1a. SlreeL . <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I.OP) O HOUSING AgATEMFNT a SOLID WASTE FACILITY <br /> TA7 UNDERGROUND TANK(UST)CLFANUP SITE( ❑ FOOD FACILrrY dSOLD VA5'rE VEHICLE <br /> I(OTHERS CLEANUP SIS(NON-LOP) .❑ DOG KENNEL ❑ DAIRY <br /> G3�UNpF_RGROUND TANK(MONITORINGfREMOVAL} � CHICKEN RANCH O .pKG TREATMENT PLANT <br /> i� AZARDOUS WASTE©ENERATOR 13 MOTEUHOTEL ❑ PUMFtP t TRLICK/YARDICHa=M TOILETS <br /> C� TIERED FERl4lfTTED FACILITY PCOf 1 C7 LANDAND USE-APFUCATiON-SITES <br /> ❑ TATT00ft300y PIERCING p <br /> D MEDICAL VIASTE FACILITY C3 OVER POOLI5PA1(PLr=AS>r SPECIFY) <br /> 1. List cap to ten addresses in the space above. Select the.type($) of fifes from the list-above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 A�4-f}138 or sT�ail to th>, <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD fileexist. An appointment For review will s be confirmed <br /> approximately five business clays but no later than ten (10) days after`recdipt of appli.ation. The files" <br /> . rr <br /> of five business days for review. Appointments should be scheduled <br /> 1 will be held for a rrla7CirnU . <br /> accordingly. <br /> 3. •A file that is actively being warl<ed on by EHD staff may not be imrnediat+<ly available for review. Anew <br /> applicatlon 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 fiie reviews by the same applicant may require a $93.00 deposit prior to review. <br /> 5. *-'ENTATIVE appointment dates must be confirmed with F_HD staff_ <br /> 6. Applications received after 3:00 pm will be processed the next business, a.y. <br /> IGON7MRPAED APPOINTMENT DATE <br /> TIME <br />{ DLITE CONFIRMED <br /> PHONE FAX INITIALS <br /> REVIEW :r) YES NO REVIEW DAT E <br /> e�ia�::.oz-0os <br /> NMOt13 <br /> i <br />