Laserfiche WebLink
FROM Geo-Phase Environmenta%.%wnc. FAX NO. : 2095690295 Apr. 21 2005 10:42AM P2 <br /> EHD LOG NUMBER <br /> D`� ��'�l (� SAN J4AOUrN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT "7 <br /> APR 9, 1 9o5 304 E Weber Ave P Floor Stockton, CA 95205 <br /> EivViriO '�v#�PdT FSE 1?168-3420 Fax; (209)464-0138 Web:www.Co.San-joaquin.ca.uslehd <br /> PERMIT/SERVIC-ES PU.DLIC REC4RD5 REL,EASFAPPLICATION <br /> BUSINESSIAGENCY: <br /> APPLICANT' '�� � "r - <br /> ADDRESS' vr� <br /> PHONE: O FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: _ Time: <br /> (please allow 10 business days from date of application Submittal) <br /> Im CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSt: 3 BUSINESS DAYS <br /> DATE �J <br /> SIGNATURE OF APPLICANT pepartment Use OnIY <br /> UNIT <br /> FILE ADDRESS <br /> p Unit 1 <br /> wQ TO <br /> a Q Unit 2 ' <br /> 4. street rftv U i 3 1 `2 i! <br /> s. street �� <br /> MV <br /> 8, street c Unit 4 <br /> r, street <br /> 8, street ra ❑ Unit 6 <br /> B. Street <br /> G <br /> 10. Strcct <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT ❑ SOUL)WASTE FACT <br /> USH <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 FOOD FACILITY c3SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 13 DOG KENNEL Gl DAIRY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 CHICKEN RANCH In PKG TREATMENT PLANT <br /> TEL <br /> HAZARDOUS WASTE GENERATOR C3 M KEEN AN ❑ PUMPER TRUCK/YARDICHFM TOILETS <br /> ❑ TIERED PERMITTED FACILITY d POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PIERCING d OTHER(PLEASE SPECIFY) <br /> O MEDICAL.WASTE FACILITY pace <br /> files <br /> m the <br /> 1. List up to ten addresses ox int S one file type MUST be eove. Select the lected f Fax too208 41i64-0138st vorb ai to the <br /> g <br /> the appropriate ( ) <br /> address indicated abpop e. y ointment for review will be confirmed <br /> 2. END will notify thea applicant if an EHL)files exist. An app <br /> approximately five mum of flys buss hut iness days forter than e review. Appointments <br /> Appointments should ays after reCelpt of pbe scheduled les <br /> will be held fo <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. now <br /> application may be submitted when the file is available. at <br /> by e condition as released will be reorganized <br /> a. Any file no'craenlr F l re fife $vhe Sam iews by the same applicant may require a$93.00Hdep deposit staff priorto review <br /> of the app <br /> 5. $TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business dad I <br /> CON>=1RMED APPOINTMENT DATE TIME <br /> PHONE .' FAX.. •'INI'T'IALS -�; <br /> DATE CONFIRMED <br /> REVII?1N1±D YES ''NO REVIEW DATE. <br /> EHD 4e�2ooa <br /> tif0llGes <br />