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0 464.8 ENVIROR�ENTAL•TH PAGE 01 <br /> tnU LW numacm <br /> LSU SAN JOAQUIN COUNTY - <br /> MAY 1 1 2004 ENVMOrrnIEN AL HEALTs DI' <br /> EPARTri:ENIg/3 <br /> 304 E Weber Ave 3H Floor Stockton,CA 95205 <br /> ENVIRONNIEP(�RMF�L(i$t3420Fax: (209)46A.-0139 Web:WWW-C0.san-jQaquir ca nslehd <br /> PERi4iIT�/•SERVICES pU-BLIC RECORDS RELYASE APPLICA.UON <br /> APPLICANT:L rn�•} ,T BUSINESSIAGENGY: 5 <br /> fr /' S�i IP z <br /> S� f ,w~ rA- 95Gg <br /> 7 Ar1DRESS: 'J� Ck <br /> 5�1'A � <br /> 2 -ka �6� FACSIMIL.E: O' 6-600 <br /> J L-PHONE: <br /> IQ r !i Ad ID GGPd✓ Time: p,OD <br /> TENTATNE''APPOINTMe"T DATE: <br /> (please allow t0 businsss days frim data of application submiCal) <br /> El <br /> CHECK BOX TO EXPEDITE REo.UEST•593.00 FEE-RE�MUE.ST PROCESSED IN 3 BUSINESS DA DATE <br /> SIGNATURE OF APPLICANT <br /> Department Use Only <br /> UNIT <br /> FILE pDDRI:SS <br /> fol 5. UJA W ❑ Unh 1 <br /> 0 5. W: c 5 bck <br /> � as 5 kM ❑ Unit 2rj� <br /> a wear S c �) <br /> s Unit <br /> Gn <br /> e svx an Unit 4 <br /> r, Slrce� <br /> at <br /> g, Slrcet Cv <br /> aa. soar <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> EIHoUsING ABATEMENT 0 SOLID WASTE FACILITY <br /> UNDERGROUND TANK 1US11 CLEANUP SRE(COP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE INION-LOP) 0 DDG KENNEL ❑ 13AtRY <br /> UNDERGROUND TANK(MONRORINGIREMOVAL) ❑ CHIMN RANCH ❑ PKG TREATMENT PLANT <br /> I{AZARDOUS WASTE GENIE p MOTELR!OTEL ❑ PUMPER TRUCK!`rARDICNEM TOILETS <br /> ` Q T7EREo PERMITTED FACILrrY -❑ POOUSPA d LAND USE APPLICATION SITES <br /> O TATT0018ODY PIERCING O OTHER(PLEASE SPECIFY) <br /> _- <br /> 0 MEDICAL WASTE FACiLnY <br /> �• e above. Select the type(s)of flies from the Its-above by checking <br /> List Up to ten addresses In the spac <br /> the appropriate box(es). At least one file type MUST be selected. Fax fn 209 464-0138 or mail to the <br /> address Inditod bove. Y for review will be confirmed <br /> 2• EHD will not theapplicant if an EHD files exist. to appointment10terrreceipt <br /> should be Sion. The <br /> approximately five business days but no later than ten(10)days after receipt of application. The cites <br /> will be held for a maximum of five bUsineSS days for review. Appointments <br /> accordingly. EHD staff may not be immediately available for review. A new <br /> 3• A file that is actively being Worked on by <br /> application may be submitted when the file is available. I be!reorganized by f prior a review, <br /> 4 Any file not returned in the same condition Sameas l aced ant may require $93.00 deposit P the expense <br /> of the appiicant Future file reviews by <br /> 5• •fENTATNE appointment dates must be confirmed with EHD staff. <br /> StREVIEWED <br /> Applications received after 3:00 I m will be processed the next business day. <br /> TIME. <br /> FIPMED APPOINTMENT DATE PHONE • FAX INff[A!S CONFIRMED REVIEW DATE <br /> YES NO <br /> EHo as.cca06. . <br /> 1.1f <br /> 0/10 39Vd jI-jVO ON snivH115 90099L90ES 57:65 7002/TT/90 <br />