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--�.]U1-07-04 01 :06PWL <br /> } P_O: <br /> ••••. �.. vv i..vu vv4u v .t.r4v1KlF`IPELNiFQ.!_�f�`�I..IH PAGE 01 <br /> DATE RCC�FIVEO �nW'ivu svWmv— <br /> SAN JOAQUIN COT;NTY <br /> ENVIR6N1VSI nAL HEAL•U DEPARTMENT <br /> 304 F lWeber Ave 3`d Floor Stockton,CA 95205 <br /> (209)468-3420 Fax:(209)464-013$Web:www-cn_A-sr►joaqu n_ca.us/ehd <br /> PUBLICRE CORDS IMLEASY,APPLICATION <br /> ApPtICANT: r G1jer1 u3C � [3USINESSfAGEN1CY= 4•L _. <br /> ADDRESS: o'ilJ�a �cQ.tdSJQ�r iSYiD /Z& <br /> 15 <br /> OW: 80, FACSWILt, <br /> Ti%NTATNE'APPOINT1iff NT LATE: 2 ^_'rime: <br /> i. <br /> (Plsssp allow 10 huainwas days frottl dafe of rppileMlon submittalf <br /> CHECK BOX TO EXPEINTE REQUE 7-583.t10 FEE-RE REST PRQCESSED*a S auzMEsS DAYS <br /> SIGNATURE Of'APPLICANT -- <br /> DATE � �� <br /> � i7evnrtrnenl Use Only <br /> UNITFILE DDaREss <br /> Al" f, dor. Cl Unit 1 <br /> z. a'tr&qt 12,C319 E. <br /> Unit 2 <br /> PeUnit 3 <br /> skree <br /> .q <br /> �►-� Unit 4 <br /> r• Sreet <br /> D 1 CI <br /> Unit S <br /> g, I <br /> .7 OA-0 <br /> ENVIRONMENTAL HEALTH pEPARTMENT FLLF-S <br /> UtjUERGRouND TANK(UST)CLlANUP SITE(LOP) C7 HOUSING Af;ATFIRENT C3 SOLID WASTE VIE I <br /> LITY <br /> orAFft CLEANUP SITE iNOI44") 0 root FACILITY O S[x1D INAST>;V7!FifCLE <br /> LE <br /> U4tMR4Ft0UM TANK(MONITORINGMEMOYAt) t? KENNEL 0 t) pu TPI(G l <br /> FIT <br /> O CHICKEN RANCH REATMEPLAIT <br /> HAZARDOUS WWASTEGBNERATI3R a TAOTNUMTEL t) PUi41PER TRuCK�'t'ARFNCFlEIjI TOILETS ~ <br /> ;MTIEfRUD PERMMED FACILITY G POOLISPA 0 LAND USE APPLICATION SITES <br /> Cl TATTOOlBQpY PIERCING 0 MER WS.EASE SPECIFY) <br /> I-i MEDICAL wAsTr.FACILMY <br /> st u pa <br /> to ten addresses in the ste abav+l. Select the type(%)pf files from the list atsova by Checici g <br /> 1. he appropriate tkox(es). At'least Ong Cela type MUST be selected. P�to 209 4dd01 a mail to tti <br /> gLdre Indica a ova. intfrleltt for review will be cantrmed <br /> 2. EHD will notify the applicant if any EHi)Rtes exist. An appointment <br /> approximately five bulginess days hot I10 later than ban(1a)days after �'g should 6a sahed isdt of appliGaUan. �iles <br /> Will be held fora Rtaximufn,of five bnSineas da far review_ .Apps <br /> accordingly. y y review. A new <br /> 3. A fits that Is actively being worked on by 940 staff fns riot.be Immediately avgitable for rt-w� % <br /> appliCgtion may be submitted when the We is avaliablw. antied b END stiff at the 0XPen90 <br /> A. Any rte not returned in tile'same condition as rel aaW will be reorg p Z93A0 depo9A prior to review <br /> of tho applicant. FuturO file reviews by the g rw d with 19 may req } <br /> 'TENTATIVE aPpaintnlent dates must be con 6rfrtad With tFHD star _ <br /> e, Applications received after'3:00 pm wilt be prooesaed ht next busir►ess day. <br /> Timir !_^~ GeJPcgl-COI s <br /> CONFIRMED APPOINTMENT DATE T <br /> f'l�ono r <br /> PATE Go.NFIRMED ,�-. PHONE FAX INI Feu 554 �s-�21 N <br /> REVIEWED YES NO izEVIEW RATE <br /> ' E 4a-o2-0Ot <br /> �18f200.1 - <br />