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DATE;RECE.IVE0 r— <br /> COUNTYFo-)E )ape SAN JOAQUIN 1_Ha qac 1`uMl=.=R <br /> Dx,;FARTlqj,:NT <br /> 304 E Weber. Ave 3r1 Floor Stockton, CA, 95205 <br /> jU1 j �, 8 2006(209)468-342 0 Fax: (209)464-0138 Web:'Aww.co_sau joaquin.ca.usCetld <br /> qq <br /> ENVIRONMENTg4MHEALTH FJVBLIC RECORDS REUEA.SE APPLICATION <br /> 03 <br /> APPLICANT�) yrA'ADDREM 13USINESsrAGENCY: I v <br /> PF30NE_-�2:L] t9 j �7 <br /> FACSIMILE: <br /> TENTATIVE*APPOINTMENT DAT:: V � � � � Time;_ bcry"i <br /> lease allow 10 busin •days om date of epplicatior submlttat) <br /> CHECK BOX TO EXPEDITE Re UE T $93.00 FEE VEST P €SSED IN 3 BUSINESS DAYS <br /> X <br /> SIC; <br /> OF APPLICANT DATE rh7ld6 <br /> eoartnx nt U Only <br /> FILE ADDRESS UNIT <br /> r s <br /> ().r` <br /> z, s7e�t ❑ Unit t <br /> t G <br /> Unlit <br /> 7. Street <br /> city <br /> s, Sheet U i�(i <br /> cilytl�ltlt 4 <br /> Y[. <br /> Street , <br /> ❑ Unit 5, <br /> !C, Sxpgt <br /> ENVIRO L UXIRPART#ti� <br /> ~YUNDERGROUND TANK(L=ST)CLEANUP SITE(L ) ROUSING MATEMENT /C3 SOLID WASTE FACILITY <br /> ')R OTHER CLEANUP SITE(NON-_0P) O FOOD FACILPIY C3 SOLID WASTE VEHICLE <br /> UNDERGROUND YANK(MONITORINGIREMOVALI CI DOG KENNET. 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR CI CHICKEN RANCH I7 PKG TREATMENT PLANT <br /> t�NTIFRED FEPWITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCKJYARDICHEIV,TOILETS <br /> 0 T.ATTOO1800Y PIERCING 0 POOL/SPA [O LAND USE APPLICATION SITES <br /> ID MEDICAL WASTE FACILITY I3 OTHER(PLEASE SPECIFY) <br /> 1. List up to tern addresses In the space above. Select the type(s)of files from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(205)464-0138 Or mall to the <br /> address indicated above. <br /> 2. EHO 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)clays after receipt of application. The ries <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 boing worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHI) 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. ITEENTATIVE appointment dates must be confirmed with EHD staff. <br /> S. Applications received after 3.00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE! TIME <br /> [SATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Iso<a. MDO <br /> wuraoa <br />