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bl/L1/Lbb4 1�:0� Lbs-Oly-�iLS MUDESIU AIC <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH. DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> _ - STOCKTON CA 95202 <br /> 12094 (200) 468-3420 <br /> PUBLIC RECORDS <br /> E <br /> pp //�� EASE APPLICATION <br /> APPL1CAl i` jkk4%*,\ BUSINESSIAGENCY <br /> AODRESS�j e(�(�- �a N L <br /> PHONE L L r l Z.:t'Z 1 FAC IMILC <br /> TENTATIVE'APPOINTMENT DATE �� TIME— Lq <br /> /Iva <br /> (Plcx;c give 7 10 19 bugiAaar,day$Froin date of app1ieati0n aUbPWW11) <br /> CHl:Ca4 BOX TO,LXPI;DITE REQUEST-$a7.on FE•C REQUE=ST PROCCSSEO 1N 3 13VSINESS DAYS <br /> SIGNATURE OF APPLICANT /h", V DATE -47m If QL{ <br /> FILE ADDRESS THIS 5113[GFiD STAFF USC ONLY <br /> i PROGRAM CLEMENTS SEARCH <br /> �t �. 41ak,M,L� Jl�tnr� ca, NI-=' '•i ..1� � � _1 <br /> r%v4 Sect*~ �l <br /> 44A-iQS7 j s <br /> `iE lvd -,.Art r-c-, 6 14-E'-� <br /> Zy_n, « K J <br /> �/ ENVIRONMENTAL HEALTH]DIVISION FILES+�.UNOEfZGFtOUND TANK(UST)CLEANUP SITE(LOP) ❑ 14OUSING A13ATEMCNT d SOLID WASTE FACILITY <br /> Q OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND YANK(MONITORINGlREMOVAI-) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR O CHICKEN RANC1i CI PKG TREATMENT PLANT <br /> C1 T1ERC0 PERMITTgD FACILITY ❑ MOTELniOTEL Q PUMP FFETRVCKNARDICHEMTOILETS <br /> Q TATTOOIBODY PSiIRCING O POOL/SPA O LAND USE APPLICATION SIT[$ <br /> ❑ MEDICAL WAST]!FACILITY ❑ PUBLIC WATER SY57EM ❑ OTHER(PLEASE SPCCIFY ABOVE) <br /> • List Up t4 ten address CS in the space above. Select the type:($) of files from the list above by Chackin0 <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)_464-0;13,8 or mail to the <br /> address indicsated above. <br /> 2. IzHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10) days after receipt of application.'The Gla, <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 EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is avallable. <br /> 4. Any fisc not returned in thO $ame 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 $87.00 deposit prior to review, <br /> 5. 'TENTATIVE appolnUnent datos must be confirmed with EHD staff. . <br /> 6. Applications received! after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT HATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW HATE r <br /> Ere vo 14 AMIMQ <br /> L <br />