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E1HD LOG NUMBER <br /> )ATE RECEIVED SAN JOAQUIN COUNTY <br /> i <br /> r 1 1to <br /> FNt IRON ENTAL HEALTH DEP TIvL NT <br /> 3044 East Weber Avenue,3r�Fltx�r,Stacktrrn,CA'�52t}2-2708I( <br /> TclephoJ e:(20�)4 -3420 Fax:(209)464.0138 Web:Nvw�v;sj c�v.c�rglehd <br /> � r'rF� t,;c �`11F �TE PTBLIC {?RD52E +AE APP �IA.'�`It�l'+i <br /> . `f a(`�v+-ri�t( s` i✓+t\s �v�•` /\ BU$INESS1A(:ZNCY:;C <br /> APPLICANT. i <br /> ADRESS: <br /> P ONE(1): � ��� - ce� PHOM1tE{Z}: <br /> 1,'i <br /> l 1x+ ? FALSE: <br /> TENTATIVE*APPOINTMENT DATE ' T1me. ti3 tatnflrmed; <br /> � <br /> (Pk w aliaw t 0 business days from date of aPP1i02tion Submittal-"7c»tactve 0 t-rn tlia <br /> a <br /> 13 CHECK BOX TO EXIEDITE REQUEST $93 00 FrEE(CASH OR CHECK'ONLY)-REQUEST PROCESSEDInt 3 8U5EtIESS:13AY3 � <br /> DATE <br /> SIGl�iATUFtE OF APPLICANT "- <br /> M Untt2 M Unit3 ' Urrit4,'" 3 Units r3Unit6 C3 t�or(elecironicltistsirriaps) <br /> UNIT DISTRIBUTION CI tlydt 1 y <br /> FILE ADDRESS EHD USE ONLY <br /> Street street Name city i <br /> 1. 0~4 T �I r caC <br /> 7. 1,4-1 raiz.•t ti-C. .��:: �' r��:4 �,e �� f+. <br /> t + 33 <br /> s <br /> i <br /># Specific Date Range of Infor;mtwn Requested:,From t1D <br /> f ENVIROOMWTAL HEALTH DEPARTMENT F ILIrS <br /> C�HouSIN+G ASATEiCiENF M SOLID WASTE FActuTY1�/EFOi V <br /> )% fi�ERGRbuNbTAkik(UST)CLEANUPSITE(LOP) tj"OUSiA�SAI M WASTE TRE <br /> 13 OTHEft'CLEANUP 5n'O.INON-Lop} 0 FOG 1{FACILITY <br /> E3 DAJRy ! <br /> 13 UNDERGROUNpTANK(Mp�gynNG(REMOVAL) ❑DOCK AYEL CH ❑WAsnwATEitTREATMENT PLANT <br /> C3 HAZARDOUS WAS TEGsE11ERATC3R 13 CHtcKEVOTEUNRAN C]PUMP R'rRuCK1YARDIGHEMT0%ETS <br /> CI Ti EKED P'ERMIT'TED FACh TTY 0POOI/SPA 0 SAND USE ArpucAnoN SITES <br /> 0 TA IO018ODY PIERCING C1 OTHER(PLEASE SPLCiFY) <br />). ❑MEDICAL WASTE F"TY <br /> WELL ANOSEPTiC PERMIT RECOR05ARE AVAILABLE FOR RMEW- MONDAY-FIODAYS:00 Am-5:0CPM - S7I1VG HdLIRRYS`. <br /> of tiles from the list above by checking the <br /> y: "i, List up to ten addresses in the space above. Seleet the type(s) <br /> appropriate boX{es), X least one file tY fae MUS7 be seteetect, Fax to 2031464-0138 car fTl�lil t�i'tite 21d rasa <br /> indicated above: Atidres5 ranges will not be accepted-for additional assistance with file addresses,contact <br /> the EHD.ApplicatIO05received after 3:00 pro will be,processed the nex(.busmeias d4y99.99 . <br /> locant if an 1rH17 flies exist. Anappointment tdr review wilt'be contirmea <br /> 2. The EHD wilt nt tiiy.t 01 tiP� y <br /> 1. approximately tan{10}.days after receipt of application. The fiiesc viii i�aa tteid for a rir�ayti�urxl of fire l�as9ness: <br /> I, daysf e,.NyW$kAppointments should be scheduled accordingly: <br /> 3 A:file that.is adds 6fy Ding worked on by EHD staff may not be Immediately avaiiabie for t`eview .Anew <br /> r application may ale submitted'when.th$file is available. <br /> 4: <br /> Any filo-not:returnetl in the sarriI'le condition as released will be reorganized by VHD st lrft of view�ense of.tlte. <br /> applicant:Futurofile reviews`by the s lme'applicant may require a$93.00 deparsit p <br />} <br /> { <br /> END:lE:G2-0G6 <br /> U14M <br /> r u: lit� uBA141eJt� �ae�=f�.O <br /> I 'd 9996-1-9`3:609 . ;_; ' <br />