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_ - eKD tati IvUMB�r: <br /> DATE RECFIv�r] t � USAN JOAQUIN COUNTY. <br /> ENVIRONMENTAL RZAx.TH DEPARTMENT <br /> 304 E Weber Ave 3"j Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209) 464-01:38 Web: www.co.san}oaquin.ca.Us/ehd <br /> pX3 ILXC ECORAS RELuA.SE APPLICATION <br /> SUSINESSIAGENCY: C) <br /> APPLICANT. <br /> ADDRESS: �0r� <br /> PHONE: FACSIMInIILE. -1 <br /> TENTATIVE*APPOINTMENT DATE: Iry3}_' , Time:_&r4- 1 <br /> (Please allow 10 business days from dale of application submittal) <br /> "")XCHECK BOX TO ExPEDM R UE T-$93.00 -REQUEST PROCESSEI?IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE . .' <br /> Dep Ent Use Only <br /> iT <br /> FILE ADDRESS r <br /> rj <br /> ,i <br /> 3. <br /> s. s«w J ,r�� a' i� Unit 2 <br /> 4. 5tr?e: I I, — \ <br /> Unit_3 <br /> 6. StreetGit <br /> a � <br /> s. svee� <br /> Fj Unit 5 <br /> ENVIRONMEN TMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP 517E(LOP) 13QUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FAC UTY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL D DAIRY <br /> HAZARDOUS wASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELtHOTEL 0 PUMPER TRUCKIYARDICHEM•TOILETS <br /> CK L7 TIERE DPERMI1800Y PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL.WASTE FACILITY <br /> ❑ OTHER(PLEASE SPECIFY} <br /> '1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At feast one file type MUST be selected. Fax to 209 464-0138 or mail W the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> approximately five business days but no dater than ten (10) days after receipt of application. The files <br /> will be hold 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 EHD staff may not be immediately available for revievu. A new <br /> appileatlon may be submitted when the file Is available. <br /> �l. Any file not retumed in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant 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:oo pm will be processed the next business day. <br /> CONFIRMED APPf)I1+ITMENT DATE TIME <br /> DATE GONFIRMI=1] PHONE~ FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE _ <br /> ersv aaazaa& <br /> WON <br />