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10/28/2004 13:24 FAX 209 94 1 W, 1j002 <br /> Cfll✓LV V.1 V/r IV V I <br /> R7ECEIVED SAID JOAQUIN COUNTY <br /> D <br /> ENYXRONMENxAL HEALTH DEPARTMENT . <br /> 304 E Weber Aye 3'1 Floor Stockton,CA 95205 <br /> (209) 468-3420 Fax: (209)4&4-0138Web:wiNw.ca.san jOaquin.ca.ushhd <br /> pLTBLIC UCO"S MLEA.SE APPLICATION <br /> APPt1CANT:_�&+`^ �5i1S <br /> BUSWESSIAGENCY: , �A X <br /> . rte• vc�-f �` � <br /> ADDRESS: 21 <br /> l e FACS[?AiLE: `•' <br /> PHONE' <br /> TENTATW A,PPpINTMENT DATE: rime,_ JZ <br /> Z I <br /> (Please allow 10 business days from date of appiic Mian subffliUaQ <br /> CHECK BOX TO EXPEOrM REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE I <br /> SIGNATURE OF APPLICANT _ ��� pepertmentEYa Only <br /> UNIT <br /> FILE ADDRESS <br /> zA „19 = l"1 13 Unit'( <br /> 2. si.eel sk 4 1J Zo`' c k _ UnR 2� <br /> Liv ^o .Tt�w L <br /> S; Sixel �i1 of aJ" y r <br /> �. sued L{QO �,_ � U flit 4 <br /> Saw Unit 5 <br /> E(�}nRpNMENTAL IAEAI-TH DF ARTM�FILES <br /> jM saLID WASTE FAu1 <br /> CLEANUP SITE(UDI') Cl HOUSING ABATEMENT ❑ SOLID WASTE VE <br /> pail UNDERGROUN4 TANK(ST)CLEd FOOD FA-ltm 0 DAIRY <br /> Eg OTHER CLFANUP SITE(MON ❑ DOG 10�NNEL 0.PKG TREATMENT PL P"T <br /> R U"r)RGROutiD TANK(MIONFrOR1NGIRfiMOVAL) o Ctil[CKEN RANCH CI PUMpERTRUCKIYAMCHEM TOIL�iS <br /> Z11AIARDOUS WASTE GE NCRATOR (3MUTELfHOTEL a LAXD USE APPLICAnoN SM <br /> [a Tr:;RED pE"rrTED FACILITY 0 pooLISPA <br /> ❑ TATToOfsoDY PIERCING ❑ OTHER 1pLFA,SE SPEC1 <br /> ❑ MFOIGAI-WASTE FACILITYchecking <br /> to ten addresses in the space above. Seieet the type($)of files from the list above by <br /> 1• Last up At least ane file type 1+ usT be selected. Fax to 2091464-0138 nr mail to the <br /> the appropriate box(es). <br /> address indicated above. ointrr►ent for review will be confirmed <br /> 2, 5HD will notify the applicant if any AHD files exist, An Bela <br /> view. Appointments should be scheduled <br /> a roximately five business days but no later the f fer�(l0)days after receipt of application• The files <br /> PP <br /> I will be Held far a maximum of Eve business ay • <br /> accordingly. not be immediately available fur review. A new <br /> We <br /> 3, A file that is actively being worked on by EHD staff may <br /> application Tray be submitted when the file is available. <br /> mea licant may require a$93.00 deposit prior to review. <br /> 4. <br /> Any fiat not ietumed in the same conditihne s.a releasped will be reorganized by WD staff at the QXQe <br /> of the applicant. Future filo reviews by t <br /> g• 'TENTATfVE appointment dates must be confirmed with EHD staff. <br /> ss <br /> ed the next business day. <br /> ved after 3:40 pm will be proce <br /> 6. Applications rece+ v <br /> `i4PPC�t3�171U1)=• •:r�:.�rd,-:•; . . . „v... .. ._,.. •: I -• <br /> w' R{� H ATE "I� , �,�: �.:�...'••,,L+ I ,_.ru;:.•• <br /> !` rPIiON FAX <br /> :Dl?.�'�GdN�jwvlEla r-., : - <br /> REVIEW DATE- <br /> NO -:- <br /> REVlEVVED YES <br /> • F.HA��-ax•aoc <br />