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B SEP.25.20021112:46PhP6g9.RRCP"9 GERRGHTY&MILLER/JSF(R"ENT'AL HE! I NO. i' P. 11 <br /> DATE acoav® 11 02 <br /> SAN JOXQUJIi1COtJNTYPUBUC HEALTH SERVICE ] <br /> NMENTAL HEALTH DIVISION �V <br /> �Ol ' STOCKTON CA 95202n�w - <br /> OF <br /> R ] n <br /> (209)4884420 � ' ,f F RV/ Ifflp S <br /> PUBLIC RECORpg RELEASE= <br /> wr2 <br /> = APPLICATION <br /> �J_ / 2002 <br /> APPLICANT TT D/�- y0.5 Gp �-�- DUSMESS/ApENCY <br /> d�L�►S rniviPnnirnFniruFoiTH <br /> ADDRESS o o iTk _� PERMIT/SERVICES <br /> PHONE Lila 2.33-3Zpp <br /> t4 FACSIMILE Flo 2.9'? <br /> y EMTAY WPOINTMENT DATEVhI <br /> 0 , <br /> (Please give 7a f TIME <br /> t■ofIlenUon s�EC <br /> K80%TO©fPE01TEROQUEST. EST PR ED 1 9 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN DATE S O Z <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> O PROGRAM ELEMENTS SEARCH O <br /> U LL <br /> OU t1 L1 �( <br /> a <br /> 2 O k a q <br /> VV I, O <br /> S L1 <br /> 2 <br /> NVIRONMENTAL HEALTH DIVISION FILES <br /> S+NDLRGROUND TANK(UST)CLEANUP SITE(LOP) O HOU13ING A9ATFMIEAIT O BOLfD WASTfi FAGILIiY�P 30 <br /> UNDER ROUND TANSITEK <br /> (NON•LOP) Cl POOP FACILITY ❑ SOLED WASTE VEHICLE= `L1< <br /> UNDERGROUND TANK(MON170RING/REMOVAL) ❑ DOG KENNF-L ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 4 CHICKEN RANCH t3 PKO TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY O MOTtLIIiOTEL 13 PUMPER YRUCWAROIC"EM TOILETS <br /> 17 TATTOOle IRODODY PEIRCINO ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY AlOVE) <br /> 1. List up to ten addresses In the space above. Seleet the typos)of!Iles 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 00 <br /> addr_essjndicated above <br /> 2. EHD will notify the applicant if any EHD flles 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 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 same applicant may require a $89,00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 64 Applications received after 3:DO pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE, TIME <br /> DATE CONFIRMED PHONE FAX' INITIALS r <br /> REVIEWED YES NO REVIEW DATE <br /> MIFF-- <br />