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Jul 01 04 03: 20p KR* & ASSOCIATES 916 2222 p• 2 <br /> 02/66/2004 12:12 4640139 <br /> DTf;f: ED SAN JOAQUIN COUNTY <br /> ENVIRONT� SNTAL HEALTH DEPARTMENT ' of <br /> J U L Q 1 2004 304 E Weber Ave,P Floor Stockton,CA 95205 �U(Q <br /> rDp �/��ggpp f ax: (209)464-0139 Web:www.ro.San-joaquin.ca.us/chd I <br /> P '.'AT/SERVICES LIC RI CASE APPLICATION <br /> ORDS RELE <br /> CCArrLtc''AAtNLL� g/�� EMINESSIAGENCY: <br /> [ADDRESS: t. <br /> FACSIMILE: <br /> CPHONE: O <br /> Tln,6: <br /> TENTATIVE'APPOINTMENT DATE: <br /> (Ploaae snow 10 b"IWA drye from dole of aPPlicsllon eebm Hart <br /> CHECK BOX TO EJ(PEOTM REQUES 0 E-REQUEST PROGE53ED IN 7 BUSNESS DAYS <br /> ��i CCC DATE <br /> -SIGNATURE OF APPLICANT Decarbnem uae Only <br /> UNIT O <br /> FILE ADDRESS � C' <br /> Uo Unit t <br /> G L o fovn^.� ❑ <br /> x. S.6. / G G V U <br /> ES c Unit 3 <br /> 4, G <br /> 0. Sra <br /> e. Tml <br /> rn 4 <br /> y o <br /> Unit 5 <br /> c, > <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �SOUD WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING FACILABATITY FIIT ❑ SOLID WASTE yEHICt£ <br /> NON•LOP) O FOOD FACILITY ❑ DAIRY <br /> OTHER CLEANUP SITE( DNITORINGIREMOVAL) C DOG KENNEL ❑ p,(G TREATMENT PLANT <br /> UNDERGROUND TANK(M ❑ CHICKEN RANCH ❑ PUMPER TRUCK/YARWCHEM TOaET6 <br /> HAZARDOUS WASTE GENERATOR C MOTELMOTEL In LAND USE APPUCATION SITES <br /> TIERED PERMITTED FACILITY O pDOUSPA <br /> C TATTOOIa00Y PIERCING [3 OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> s of files from the list above _m it tot e <br /> List up to ten addresses in the spacng <br /> e above, Select the type( ) <br /> t. At Mast one file type MUST be selected. F x to 209 egq-(1738 or mail tot e <br /> the appropriate box(es). <br /> ddress indicated above. appointment for review Will bconfirmed <br /> files <br /> EHD W III notify the applicant it Y5 :HU files exist An sppo after receipt of application.dined <br /> 2• Appointments should be sobs <br /> approximately five business da but no tater than ten vie aye <br /> will be held for a maximum of flvo business days for review. <br /> accordingly. <br /> 9. A file that is actively baing worked on by EHD staN may not be immediately available for Teview• new <br /> ybe submitted when the Lila Is available. <br /> application marequire a d by E deposit prior to Lavaca. <br /> q Any fits not returned In the same cc applicant as released anti be reorganized 3,END stall p the o review. <br /> of the a noappltcant. Future file reviews by the sane applicant may <br /> 5 "TENTATIVE appointment dates mm�billb°°nd lthe next buth EHO siness day. <br /> 6. Applications received atter 3:D0 p <br /> processed <br /> TIME <br /> CONFIRMED APPOINTMENT DATE PHONE FAX INITIALS <br /> DATE CONFIRMED REVIEW DATE <br /> YES NO <br /> REVIEWED •F. .2 P��- 52i�0 <br /> �UaS Jen?le fvr <br />