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04/05/2006 13:27 FAX [a001/001 <br /> DATE RECEIVED 5;%N JOAQULN COUNTY <br /> � �� YiRU�` iEi�TAL :II.THDEP:�RTNf i`(T <br /> EE -1p <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> 468-3420 Fax: (203)464-013.9 Web: wtivtiv.co.sau joaq�ia.ca.tLy�ehd <br /> ENVIR011"INt!ENT HEALTH PUTLIC UCOPDS RELLkSE APPLIC'UO..'i <br /> r <br /> , . .BuSiNESS1AGENCY: <br /> APPLICANT. <br /> ADDRESS!_ Z`�••j$� �.. � _ ��-�.�� <br /> PNOtYIw FAQ$IM1LE: <br /> TENTATIVE'APPOINTMEN'C DATE: ! _-„�..---. <br /> Tuna: <br /> (Please allow III business days from date of application submittal) <br /> C3 CHECK BOX TQ E"EDITS RE!&� <br /> OCESSED IN]BuStNESS DAYS <br /> . DATE <br /> SIGNATURE OF APPLICANT �� DeparuncntlJ9a Only <br /> • UNIT <br /> FILE ADDRESS <br /> G Unit 1 <br /> city <br /> a <br /> F *e Unit 2 <br /> Unit 3 <br /> _'"�(,,,J�v � S•t" !fit' R tC- u �,� r� <br /> 8` Sroei '-7 1 �. '.r tInit 4 <br /> C S• S't 12-r _C2 „G ,._ d1 � - <br /> ctcIa Q Unit 5 <br /> S-L'7G <br /> EWIRONMENTAL'HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SI'M(LOP) CI HOUSING At3AT6MENY 14.SOLID WASTE FACILITY <br /> OTHER CLEANUP SCCI: (NON-LOP)PP) 13 <br /> FOOD FACILITY Q SOLID WASTE VEHICLE <br /> � UNDERGROUND TANK(MOMTORINGiREMOVAL) © DOG KENNEL I-DAIRY <br /> X HAZARDOUS WASTE GENERATOR 13CHICKEN RANCH 3-FKG TREATMENT PLANT <br /> ❑ TIERED PERMrrTED FACILfIY 0 MQTELIHQTEL © LANDpUMpR" APPLIYAF blN S'rN TGtLETS <br /> ❑ TAYTOOMQOY PIERCING D POOVSf A �` LAND USE APPLICA770N SITES <br /> 0 MEDICAL WAS7C FACILITY 0 OTHER(PLEASE,SPECIFY) - - <br /> 1- List up to ten addrasse„in the space above. Select the type(S) of utas from the list above by checking <br /> the appropriate box(es). At(east one filetripeMUST tae selected. Fax to 209 464-0138 or m3i1 to the <br /> address indicated above. <br /> 2• EHD will notify the applicant if any EHn files exist. An appointment for review will b,I c4ion, The files <br /> approximately five business days but no later tl•ian ten (10) days after receipt of appiic anon, Th. <br /> will be held for a maximum of five business days for review_ F.npointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worsted on by EHO staff may not be immediately available for review. A new <br /> application 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 cite: expense <br /> re a X93.00 deposit prior to review. <br /> of the applicant, Future file reviews by the same applicant may requi <br /> S. -TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> col F.�Rrr��o.APPOINTMENT:DATE: _ -'�'- • ,� <br /> =DI?rTE GQNFlRI4iED -- — ..PHONE <br /> 7EViEV•:ED YFS NO • R�VIE'N !SATE �._T— <br />