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SER OE6vF34r} J��� D 6x0138 <br />ENVIRONMENTAL I-EALTHO <br />>A SAN JOA.QUIN COUNTY <br />ENVIRONMENTAL HEALTH ]DEPARTMENT <br />MAY 11 2004 304 E Weber Ave 3`d Floor Stockton, CA 93205 <br />ENVIRONPdIEa*Ayjgt3420Fax: (209) 464.0138 Web. wyw.co.san joaquinca usJehd <br />PER IT/SERVICES �USLIC RECORDS gELI ASE APPL11CAT10N <br />�aT <br />PAGE 01 <br />tr1U LW NumCCR <br />I8/3 <br />BUSitinSIAGENCYt �r � r„% iJik�in4rr <br />APPLICANT: <br />�AODRESS: 3� (A00 <br />(p -(O00 . <br />(Q2 FACIsMUZ: ! 6 <br />i. -PHONE: K C t• 1j -e !n c e Time: a •O� <br />TENTATIVE" APPOINTMENT DATE: <br />(Please allow to business days from data of appUGltlon submiCaO <br />❑ CHECK BOX TO EXPEDITE REQUEST • $93.A0 FEE- REQUEST PROCESSED IN 313USINFSS DAYS <br />DATES i ydf <br />.� �•rr lop OF APPLICANT Depanmem Use Only <br />ENVIRONMENTAL='r, <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />❑ EptlD PACIUTY <br />OTHER CLEANUP SITE (NON -LOP) <br />UNbEEMOVAI•) <br />ROROUND TANK tMONITORINGIR <br />C3DDG KENNEL <br />❑ WIMMN RANCH <br />h p,FiouS WASTE GENERATOR <br />C3 MOTEL nIOTEL <br />` ❑ TrERED PERMITTED FAGVJW <br />LING <br />❑ poouSPA <br />THEIR (PLEASE SPEC <br />E] LINO <br />[� Unit 2 5 <br />Unit 3 <br />Unit 4 <br />�] Unit 5 <br />❑ SOLID WASTE FACILITY <br />❑ SOLID WASTE VEHICLE <br />❑ DAIRY <br />❑ PKG TREATMENT PLANT <br />❑ pUMpMTR11CK1YARDICH'EMT <br />O LWD USE APPLICATION SITES <br />U13 TATTOO/Boov PIER G O chNCK nq <br />1� ❑ MEDICAL WASTE FACIL" $ of files from the list above by <br />1. List Up a MUST be selected. Fax to 209 464-0138 or mail to the <br />to ten addresses In the space above. select the type( <br />the appropriate box(es). At least one flle type <br />address indicated above. Et►D fifes exist An appointment for review w)il be confirmed <br />2 EHD will noti Y the applicant if da after receipt of application. The files <br />for rovlew. APP°inf ents should ba sohoduled <br />approxlmatel five 6u5iness da but no later than ten {10 <br />will be hail for a maximum of five business days not be immediately available for review• A neW <br />accordingly. erkad en by EHD staff may <br />3• A file that is actively being w <br />application may be s�bm�tted when the fila is available. uire a $93.00 deposit prior to review. <br />4 Any file not returned in the same condy the same applicant may req anlzed by EHD staff at the expens <br />of the applicant- Future file review's by <br />g `TENTATIVE aP,ointment dates must be confirmed with EHD staff. <br />ti <br />*TENTATIVE <br />tions received after 3:00 pm will be processed the next business day. <br />TIME- <br />FeCONRPMED APPOINTMENT DATE PHONE . FAX INITIALS <br />O—N —.— <br />DATE CONFIRMED RFVIEW DATE <br />YES NO <br />REVIEWED <br />ENo a6.c..-Oo6. <br />-dI-ltlO ON snivaiS 50099L90E5 54:6L 400i;/LL/90 <br />0/L0 39tld <br />