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0002 v <br /> CI••IV�,VV 1\VlrWbl♦ <br /> 10!28/2004 13:24 FAX 209 948 SAN JoAQZTA`j COZTN� <br /> DA RECEIVED <br /> WMoNMENI'AL HEALTH DEPARTMENT <br /> 344 E V'Teber Ave 3rd Floor Stockton,CA 95205 <br /> Ll <br /> (209) 458-3420 Fax: (209)454-0138 Web:WWW-cO.san joaquin.ra uslehd <br /> PU13LxC pXCOnS MLEASE AypLICAYTION <br /> l BIJStNESSIAGENCY: <br /> ADDRESS: <br /> �� h, FACSIMILE. O <br /> PHONE: /Z b- <br /> Time: <br /> TENTATIVE•APPOINTMENT'DATE: <br /> (p{ease allow 10 business days from data of application subm'eaa9 <br /> CHECK BOX 70 EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYSDATE � � <br /> SIGNATURE OF AFFL.ICANT Department Lisa Only <br /> UNIT <br /> PILE ADDrtEss �+� _ ^� ❑ Unit 1 <br /> z. skeetIas _ , �;;f Unit 2) 1 0� <br /> Wn v w k U4 ,.�t Unit 3 1 <br /> TZo G a s^ <br /> �.. 7 <br /> s: sty 3 uoo <br /> 01" <br /> Unit 4 <br /> 6. Strew w:. <br /> sued <br /> t �. ,f ❑ Unit 6 <br /> Suax � CI ' <br /> 70. sr'tet� <br /> ENVIRONMENTAL HEALTH DEPARTM�T FILES <br /> ❑ HOUSING ABATEMENT I�9 SOLID WASTE FACILITY <br /> CLEANUP SnE:(LOP) d ioUS FP.CILAT ❑ SOLlO WASTE veHICLE <br /> qk UNDERGROuNo TANK(t1STIl�Op) ca DAIRY <br /> a OTHER CLEANUP Sat(NON d DDG KF-NNEL pKG TREATMENT PLAIIT <br /> § Ut{DERGROUND TANK(MONI70R1NG1REMOYAL) O C4iICKEAt1 <br /> N RCH ❑ PUMP TRUCKfyARJYCHEM TOILETS <br /> fg HAZARDOUS WASTE GENERATOR ❑ MOTEL►HOTF-I <br /> ❑ 'UERED Pp.RMrr7ED FACILITY p pOo JSPA fB LAND USE APPLICATION 5(rES <br /> ❑ TA-rTWMODy PIERCING i7 OT}¢R(PLEASE SPECIFY) <br /> D MEDICAL WASTE FACILITY checking <br /> to ten addresses in the space above. Select the VPe(s) of files from the list above by <br /> 1. Last up At least one file type MUST be selected. Fax to 209 46.4-0 l38 or mail to the <br /> the appropriate box(es)- <br /> address indicated above. ointment for review will be confirmed <br /> 2 EHD will notify the applicant if any EHD files exist <br /> An aFP application. The files <br /> five business days for review. Appointments should be scheduled <br /> approximately five business days but n4 later than ten(10)days after receipt of a p <br /> will be held for a maximum <br /> accordingly. not be immed <br /> 3, A file that is iately available for review. A ner� <br /> actively • <br /> being worked on by EHD staff may <br /> application may be submitted when the file is available. <br /> mea licant may require a$93.00 deposit prior to review <br /> An file not returned in the same condition as released will be reorganized by EHD staff at the expene <br /> 4. Y the same, PP <br /> of the applicant. Future file reviews by <br /> g• 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> ed the next business day. <br /> g_ Applications received after 3:00 pm will be procesTIME <br /> s <br /> APP�INTMjr :. .x <br /> Gt�NFIRM NT pP.T <br /> D <br /> � <br /> ;:. .. ,,. rPF10NE . FAX'" <br /> :DATE- ONFIRIVIEQ REVIEW DATE' <br /> REV1EVVED YF-S NO _ <br /> • FNR�!-U2Ao6 <br /> yyjOU] / <br />