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5106559517 T-580 P.01/01 F-654 <br /> 03 26-03 10:51 am I'mm-ENVIRON EUaVVILLE •^^ <br /> 03/10/2UU:3 13,j:u3 .o" SA'CES <br /> nATE aECitvEa SAN JOA4UIN GOUNTYPUBUC HEALTH <br /> ENVIRONMENTAL HEALTH DIVISION n� <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOC'KTONCA95202 <br /> (209)468-3420 <br /> ::f <br /> MAR 2, 6 2g�lgL1C RECORDS REQ-EASE APPLICAT�'�Kx^� �— <br /> �t.)v \20 <br /> BUSINESSIA5ENr1�� <br /> APPLICANT �- <br /> lADORESS 5 5� FACSIMILE <br /> n <br /> PHONE TIME �---- <br /> TENTATIVE'APPOINTMENT GATE loess days from date of appliaatien sunmlttnil � ' 2 <br /> (Please give 7 to 10 nus 7 <br /> REQUEST PROCESSED IN 3 BUSINESS <br /> 13CHECK BOX TO EXPEDITE REQUEST•$B9.00 FEE- DATES '_ <br /> j�SIGNATURE OF APPLICANT aa•^-�"_ �� <br /> THIS SIDE LI TAA;'ISE <br /> ONE <br /> PROGRA—M� 113 +Iris SEARCH <br /> PILE ADDRESS 5 21 A —1 --. <br /> u � <br /> ENVIRONM ENTAL HEALTH DIVISION FIL�OIJD wASTC,F ACILITY <br /> �/ ❑ HOUSING ABATEMENT O SOLID WAS11:\FEHICLE <br /> V,t}NDERGROUND TANK(UST)CLEANUP SITE lLOP1 I7 FOOD FACILITY ❑ I)AIiRY <br /> re �F ER CLEANUP SITE(NON-LOP) 11 DOG KENNEL ❑ PKC,TREATIdENT PLANT <br /> C NDIERGROUNDTANK(MONITORIN6lREMOVAL) ❑ CHICKEN RANCH C1 puMPERTR'UCiUYARDICHf3MT171LIaTS <br /> �ARDOUs WASTE GENERATOR ❑ MOTELMOTEL ❑ LAND USE Ap`PLICATION$�O1/E} <br /> t7 pOOUSPA p 0T1'IGR(PLEFSE SPECIFY AB <br /> OI <br /> PERMITTED FACILITY ❑ che2ldng <br /> ❑ TA7TOOIBODY PEIRCING <br /> D MEDICAL WASTE FACILITY g S Of flies from t11E: lilt 138 orbrn I to tiye. <br /> to ten addresses in the space above. Select tbe gQ?ected. Fax to 2 e }i:( '- L <br /> List up pt least one file type MU <br /> the appropriate box(ea). <br /> S ' dtc ed above EHO fates exist. An aPPointment for review moll blicatioTira'Filer• <br /> EHD will notlfy the applicant if any da s after n,c is of uld <br /> 2 a but no later than ten(10) Y oint:m4!nts should b®scheduled <br /> approximately <br /> fva business days <br /> business days for review. App <br /> wail be held for a maximum of not be immediaetely availstble for reviev+. F,new <br /> accordingly being worked on by EHD staff may at the expense <br /> 3 Afile that is actively EVID staff <br /> appllwdon max be submitted when the-on is available. a$8g•fiil deposit prior to review• <br /> ,tnia:ed by <br /> ltcant. Future fife pevlews by the same apPllcant may require, <br /> 4 Any file not returned In the same condition as released will be reor <br /> Of the app a Int rens dates must be Confirmed with EHD staff' <br /> 5. ENTATIwE PP° rn will be processed the next busin�as s day. <br /> Applications received after 3:00 p <br /> 6. 7671 C'e10 CYI� a!wo -tet <br /> past-Its Fax Note �, <br /> ENT DATA — �A��{ D��r�Va�--°"` <br /> CONFIRMED PHO u�a+• phma� 09 y �'j_ ZL <br /> DAfI CONFIRMED " <br /> REVJMED <br /> ves NO Fox. 510�G 55 �y -- _.. 4r.LN <br />