COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

07/13/2005 09:06 209-579-9025 MODESTO ATC PAGE 02 DATE RECEIVED ENd LOG NUMHI SAN Ji>'AQIJnv COUNTY` MD (��E�., ^vEo ENVIRONmINTj kL 13 FALTH DEPARTMENT I� 304 E'Weber Ave 3r°Floor Stockton,CA 95205 JUL i 3 M 468-3420 Fax: (209)464-0138 Vkeb:www.co.san joaquin.caus/ehd LN�IRONMENT HEALTH PIJBLIC RECORDS Mt LEASE APPLICA: 100 PERM11/4 'E' APPLICANT: 4 BU i}ESS/AGENCY: _ T^C. � \�SGS C' / ADDRSS' J —� tl Y �( PHONE: " � � I FACS MILE: `272-7 S� TENTATIVE*APPOINTMENT DATE:A� ' Z O- d_� Time. � ' C7o r (Please allow 10 business i days 'r=date of applteelon aubmftl) r L CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REC VEST aROCESSED IN 3 BUSINESS DAYS in I SIGNATURE OF APPLICANT , DATE De"rtment Use Only FILE ADDRESS UNIT sa..s ab ❑ Unit 1 CRI s ❑ Unit 2 s aUnit 3 s. a -AUM L61' 7. 0910 Sheat Unit 4 4. 0 E. Street ❑ Unit 5 �^ ENVIRONMENTAL HEALTH DEPARTMENT FILES P UNDERGROUND TANK(UST)C UP SITE(LOP) I3 HO MING ABATEMENT ❑ SOLID WASTE FACILITY k!"QTHER CLEANUP SITE(NON4. P) ❑ FCA)O FAOILITY ❑ SOLID WASTE VEHICLE UNDERGROUND TANK(moNrm RING/REMOVAL) ❑ DO's KEN VEL ❑ DAIRY HAZARDOUS WASTE eENERA ❑ CH CKEN RANCH ❑ PKQ TREATMENT PLANT Q— iF-RBD PERMITTED FACILITY ❑ MO rELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS ❑ TATTOOtBODY PIERCING ❑ PCA)L/SP1t ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTT IER(P CEASE SPECIFY) 1. List up to ten addr see in the space abo ie, 3'Iect the type(s)of flies from the list aboys by checking the appropriate box(es), At least one file,ype MUST be selected. Fax to(209,)464-0138 or mail t2 the address indicgl2g above. 2. EHD will notify the applicant If any EHD f1a as exist. An appointment for review will be confirmed approximately five business days but no I Mart Ian ten (10)days after receipt of application. The files will be held foram Imum of five bus(ne:4 dabs for review. Appointments should be scheduled 04 accord rn Y. 3. A file that Is activel being worked on by I ND attlff may not be Immediately available for review. A now Q application may be ubmitted when the fii s Is a sellable, 4. Any file not ratUrnel In the same conditio i as released will be reorganized by EHD staff at the expense of the.applicant. F ture file reviews by tho same applicant may require a$93.00 deposit prior to review. 5. "TENTATIVE appoir tment dates must be c onflr red with EHO staff. 6. Applications recely after 3:00 pm will bt.processed the next business clay. CONFIRMED APPOINTME DATE _ TIME DATE CONFIRMED PHONE FAX INITIALS . REVIEWED YES NO REVIEW DATE ..soo torer:oo�