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SAN JOA,QUIN COUNTY �"� EHD LOG NUMSFER <br /> D 1�V1FONMENT L HEALTH)D,, Ab)4,l ENT <br /> �� VD 304 E-Weber Ave P.Floor Stockton, CA, 95205 <br /> (209)468-3420 Flax. (209)464-0138 Web: www.co.san_joagUin.ca.us/ehd <br /> MAR - 9 2006 <br /> 25 7 <br /> Pu13LIC RECORDS RELFA,SF, APPLICATION <br /> � _RVML621 I BUSINESS/AGENCY- l�1Q [ l f � <br /> - �a,h ,fid C. <br /> ADDRESS: 0 '2_ k V%r' rF"+�`a`x � <br /> PHONE: J 'c? FACSIMILE: — T-Z'� <br /> TENTATIVE*APPOINTMENT DATE:—✓I J_ �.P Time: <br /> (PTease allow 10 business days from date of application submittal) <br /> CHECK 130X TO EXPEDITE:REQUEST-$9,100 FEE- Qt3EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURIr OF APPLICANT DATE .3 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1, Street 0 s2+ et ._ <br /> z. Strait'Ll at * f a 0 Unit 7' <br /> J. Strect v y h. 't 1 <br /> Z-On AJ 61 <br /> S. StmetG - A MO" <br /> - Unit'3'-. <br /> Un#4 <br /> I <br /> 8. 6th}t M .r <br /> 10, Streel 4,J Unit r3 q <br /> 'k <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) .Q HORSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ POOD FACILITY ❑i SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONMORINGIREMOVAL) ❑ DDG KENNEL 4!DAIRY <br /> HAZARDOUS WASTE GENERATOR .G CHICKEN RANCH D I P100 TREATMENT PLANT <br /> TIERED PERMITTED FACIf,r1Y b MOTE UHOTEI, Q IPUMPER TRUCKIYARDICHEM TOILETS_ <br /> ❑ TAT70011300Y PIERCING 4 POOLISPA 0 •,LAND US1=APPLICATION SrrES <br /> ❑ MEDICAL WASTE FACIL.ITT 11 OTHER(PLEASE SPECIFY) <br /> .S. List tip 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 least one file type MUST be selected. Fax to 209 464-0738 or mail fa 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 later than ten(10) days after.receipt of application. The files <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• Arty file not returned in the same condition as released will be reorganized by IEHD 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 3,00 pm will be processed the next business day. <br /> i <br /> EDATECONFIRMED <br /> ED APPOINTMENT DATE <br /> TIME <br /> PHONE FAX INITIALS YES NO REVIEW DATE <br /> ctiu�a-a2.�os ' <br /> tlra�xoas <br />