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v <br /> TO I7'M3512423 <br /> 09-12-2we1 e8'-P1BFN FR:]C1 LIIIH,/Y 1141iV11 l'//, <br /> " '.,�...... Spp� R!JOAQUIN COUNTYPUlC HEALTH SERVICES } <br /> '411SEP 12 AM 9 �tl ENVIRONMENTAL HEALTHDlVIS10N <br /> V 3D4 FAST YY.13ER AVENUE,THIRD FLOOR <br /> I STOCKTON CA 95202 <br /> (209)415 3420 <br /> PUE LOC RECORDSRr-1 EASE APPLICATION <br /> APPLI HT BUSINESSrAGENCY <br /> Sg431 <br /> ADD eol t• :OL.SA- C t I 3 1 - �.•f�-3 -- <br /> 'PHON1S� �Y� FACSIMILE,_,— SM <br /> dNTMENT PATH TIME • <br /> TENTATIYE•APP: =� <br /> {Pleas pvc 7 w 10 U LZiMA4•ay&from tlaty of apPltUeoO SuBmiUail <br /> M�c ECK DOX TO CxPEGI'rE REQUEST•S07.DC FEE-REQUCST PROCESSED IN 7 BUSINESS DAYS I CFP 1 7 nnni <br /> DATE l O <br /> SIGN TURF Of APPLICANT <br /> I <br /> THIS SIDE EX D STAFF Use ONLY <br /> FILe ADDRESS PROGRAM ELEMENTS SEARCH �Uo'61:36 <br /> � :Z f=/loDa9635' <br /> � � O <br /> I V <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> / CI SOLID WASTE FACILITY <br /> G`Uri EKGROUND TANK tU$T)CLEAN UN 817E(LOP) ❑ pOOpIFACIL6{TYEMEN7 ❑ SOUP WASTE VEHICLE <br /> ©>O i E CLEANUP SITE(NON•LOP7 D DAIRY <br /> Cl UNNIXOROUNO TANK tMoN1TORINGfREMOVAL) 0 DOG KENNEL ❑ p�TREATMENT PLANT <br /> ®'H OT <br /> O <br /> DUSWASTEGENERATOR O MELiNRANCH 7C3 pUMPERTRUC19YARDICKEW TOILECS <br /> EL O LAND USE APPLICATION SITES <br /> ❑ TIERED PERMITTED FACILITY O PO ODUSPAUSPA E <br /> Cl 18 <br /> TA'(Td0DUY PCIRGING � p PUOLIC WATR SYSTEM ❑ OSH6R(PLEASE SPECIFY ACOYE) <br /> ❑ M ZAL WASTE ACILnY <br /> 1, List up to ten addresses in the space above. Select the types) of files from the Eist above by checking <br /> the appropriate boX(Ds).'At least one file typ&MUST be selected. Fax to z 9 64 38 or ma' to t <br /> ad reSS I icat¢d above. <br /> Z, I ' EHD Wil)notify the applicant if arty END fltos exist. An appointment for review will bo confirmed <br /> approximately five busirioss days but no later than <br /> an ten(10)days o ntmontfter sshouldt of e Scheduled flles <br /> will be hold for a maximum of five business days for review, App <br /> accordingly. <br /> 9, ly being wotkod on by EHD staff may not be immediately available for review. R n¢w <br /> A Site that is active <br /> I application may be subtxiittod when the filo is available. <br /> G, Any lilo not returned in%11110 Sarno condition as rcicascd will bo reorganized by ZHD stat(at the expense <br /> of tho applicant, Futiue tilD reviews by the same applicant may require a 5B7.00 deposit prior to review. <br /> $, 'TENTATIVE app°intmetlt dates must be confirmed with EHD Staff. <br /> G. Applications received atter 3:D0 prtt will be processed the neXt business day. <br /> I <br /> I . <br /> CON�IRMED APPOINTMENT DATE TIME <br /> I . PHONE FAX INMALS r <br /> DATjCIONFIRMED fl <br /> REvI WED YES NO REVIEW DATE <br /> TOT iiL P.01 <br /> rr: : 91:n inn7. TT d;c, 47.17-> i-tiJJ:XP { ntd�r - Nn'H}il�l <br />