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4 <br /> y5 r� �y.� �� I.Yr � • — <br /> v .-.v J Z' <br /> L"1 IV lVV IV VIVi<71.1\ <br /> SAN JOAQUIN COUNTY <br /> ENVXRONMLNTAL IIEALTH DEPARTMENT <br /> - — 304 B Weber Ave 3r6 Floor Stockton, CA 95205 LAO <br /> 468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin_ca.us/ehd <br /> APPLICANT;_ ZA C_X BUSINESSIAGENCY: EN 666 60 <br /> ADDRESS:, ��6$Ca /V �iP�"S� igLUt� 3 7/ kW mid 9 <br /> PHONE: 2 02• $85'4c/o FACSIMILE: 204' 35_66�'S <br /> TENTATIVE*APPOINTMENT DATE: ASA R <br /> (Please allow 10 business days from date of application submittal <br /> CHECK BOX TO EXPEDITE REQUEST-395.00 FEE-REQUE$T PROCES$FD IN 3 BUSINESS DAYS <br /> �/�� DATE <br /> SIGNATURE 4/R�ldSIGNATUREOF APPLICANT 1 <br /> Department Use Only <br /> FILE ADDRESS UNIT J <br /> a / Unit 1 <br /> hl/ z. sued T GJP I7 sTy <br /> UST I 3. s 0oxf.5 ROA • 70d / Unit 2 <br /> Lk sr t l L •. slf 21250 tpbgjs fwjo G 7 0 <br /> �. 17ea-Izd v , , <br /> �\ u s :�v S. s d R b1►tc / Unit 3 <br /> V� iAs-r 6. crest t�Dll O 1 1d76� <br /> T. streetrill Unit 4 <br /> a. S44-et <br /> 9. Street <br /> C UnitcAlnUlKAJU 61113 U 60 —L <br /> c <br /> 10. SI-4 GI - <br /> ENVIRONMENTAL-HEALTH DEPARTMENT FILES <br /> f <br /> ONDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT OLID WASTE <br /> THER CLEANUP SITE(NON-LOP) FOOD FACILITY _SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONiTORINGIREMOVAL) �OG KENNEL �DA)RY + <br /> IAZARDOUS WASTE GENERATOR CHICKEN RANCH KG TREATMENT PLANT <br /> _,Fr <br /> PERMITTED FACILITY TEUHOTEL UMPERTRUCKIYARDICHEM TOILETS <br /> 13 TATTOOIBODY PIERCING POOOUSPA 1 ANO USE APPLICATION SrrES . <br /> MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) ±� <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At Least one file type MUST be selected. Fax to(209)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD 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)days after receipt of application. The files <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 being 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 EHD staff at the expense <br /> of the applicant. Future file reviews by the sarne applicant may require a$93.00 deposit prior to review. <br /> v. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX' ANIT1ALS' <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48-02-005 <br /> al8/Z00S <br />