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AGE STOCKTC3N <br /> -� . PnGE 02/6 <br /> DATE RECEIVcD [ / <br /> � SAN JOAQUIN COUNTY EHO LOG NUM,DER <br /> L� ONNTENTAL TIC, 4.LD + <br /> 304.FsWeber Ave 3rd Floor Stockton C A9° NT <br /> AUG W027 :I20� <br /> s�20 �'�:.�..«Cig) �6�_4;38 Web. u�v.co.san,jop-,quirz,ea.us/ehd <br /> CATION <br /> APPLICANT: <br /> BUS.INESSIAGENCY- <br /> ADbRESS: � <br /> PHONE: - A ------- „ <br /> TENTATIVE*APPOINTMENT DA.Tr, <br /> (f�9®a���t,�,�. �hu�lrto��days Prom date of�{�p1;G�tion;stNbrnittall �' <br /> CHECK BOX TO ExPEIDITE REODE <br /> "93.GG'ZE�E--REQUEST PFiOCESSEI)IN 3 HE1SiNESg DAYS <br /> SIGNATURE OF APPLICANT <br /> - L7epartm�r�tiJsE`Orty��� <br /> UNIT/. <br /> et- <br /> Unit 1 <br /> 'TV unt 2 <br /> 7. -- cRV Unit 3 <br /> l <br /> B. 6tree: Cli nit 4 <br /> 1Q. <br /> Uri it 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FIIJI S <br /> UNDURGi OUND TI.ANK(UST)CLEANLIp SITE(L O-Pp IiC1USINq A<3Afi IyIIEN! <br /> QT iER CLEANUP SITE(NoN.Lop) � $0I Idl BASTE PACIEJxy � <br /> UNDERGROUND TANK(MONJTORjNn'R1—'HSV L C7 �bQU FACILITY <br /> HAZARDOUS WA5TE GENZPATOR ) OG KENNEL � DAIRY�°�dSTlb VEHIC�E <br /> TIERED PERmr-FTE'D FACILITY 0 CI�IGKEN RANCH � I]AfRV <br /> TATTOOIBODY PIERCING O MOTELINOTEL � PKG TRCATM ENT PLA14T <br /> MEDICAL WASTE FACILITY ''-I POOLISPA � PUMPER TRUCICIYARb/CkiEm TOILETS <br /> I-J OTI'ICR(PLEASE SPEGIFy) In LAND USS APPLICATION SITES <br /> 7. 1-pat up to ten addresses In Sin3 above, 2peat the <br /> the appropriate bax(es). At Ivas9 r,ra yp typ�e(s)of files from the Iest above by Checking i <br /> address inrtieated above, a filet e MUIST he SMOCted. F-`�x; to X09 �6�1-Q f 38 n <br /> 2. EHL]will n0f1fy the applicant if,14 EHf�files exist. Anarevj6w Il�ail n the <br /> approximately five business el�y peat rao pater than tars ( ] dam after receipt f all�lgbQ llCatio lrM h <br /> Will be held far a Itlaxim"m of five <br /> I�asirress day far review. APPOinfinents should be Scheduled <br /> accartpingly, The files <br /> 3• A file that Is activelybele vs 2cec � , <br /> it o"s' _ d by EE( staff available, <br /> not be IIIlrrsea ately avalpable for review. A new <br /> al3pticat.irsn may be submitted a°°UI,eE tlje file Is avaf ma <br /> `I• Any file riot returned in the s8MO Cbrl <br /> of the apl�lieart, Future file e je. . rliticha as rePeasad•wall#3e r�csrgataizen° by£HC st <br /> at the expense <br /> 5- `TENTATIVE a rrs j- the c Same applicant May require a$93.00 deposit prior t0 rev ew, <br /> p�pt}infrraePlt c ls. fia� yi btu�cafafiarn d with EHL)star. <br /> 0 Applications received after `. I;, para�nri&l tae processed the rst;xt bnsirIoss day. <br /> CONFIRMED APPOINTMrNT DATE <br /> DATE CONFIRMED � � TIME�T— <br /> E REVIEWED "" PHONE7 FAX INITIALS <br /> YES I,�C <br /> Fit'41-02-0p� <br /> REVIEW DATE <br />