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DATE I:ECCIVED 0 EHD LTJ(;NUMBER <br /> SAN JOA.QUIN COUNTY 40 <br /> ENVIRONMENTAL 1JEALTII DI;P.A.1 7'MENT <br /> 304 F Weber Ave 3"Floor Stockton,, CA. 95205 <br /> (209) 468-3420 Fax: (209) 464-01,38 Web: www.co.san jvaclu0 ca.0 c24 <br /> PUBLIC RECORDS :kICLEA,SE APPLICATION <br /> APPLICANT: (,c BUSINESS/AGPNCYp p�1 f (�� }1�g1�17ti�//y� --►- <br /> ADDRESS: qy I— l S Y1���Q_, ¢ - <br /> PHONE;...... FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE:I T- � � D� Time_ 1? <br /> (Please allow 10 business days from date of application I <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PRoCES U DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS <br /> UN <br /> iT <br /> O( T� <br /> '12. Slrfri F ' v1 � ` Q CI \Vr` I_7 Unit 1 <br /> Lir) JA <br /> 3 I �r11 Unit 2 <br /> K. Street Gy-���W �/ - C!r.'�7]�, fw K6 Unit 3 <br /> Srrrrrl �r I 1 9�ti� PCs R al <br /> \\ �. � n . ��� P -. 1 1 — OI '46 I Unit <br /> saecl y n- <br /> Unit 5 <br /> t 3rlo tisev. � �, go <br /> �TH <br /> OGSENVIRONMENT H DEPAR NT F L <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 1� OTHER CLEANUP SITE(NON,LOP) ❑ FOOD FACILITY © SOLID WASTE VEHICLE <br /> 7C UNDERGROUND TANK(MONITORINGIREtMOVALr/ © DOG KENNEL ❑ DAIRY <br /> V HAZARDOUS WASTE GENERATOR-/ O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY./- Aoft © MOTELIHOTEL Q PUMPER TRUCKIYARD/CHEM TOILETS <br /> F-I TATTOO/BODY PIERCING C1 POOL/SPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list aboye 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 EMD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> 5. *TF-NTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> F <br /> IRMED APPOINTMENT DATE TIME <br /> ONrIPMED PHONE 1=AX INITIALS <br /> WEL) YES NO REVIEW DATE <br /> 2Ho <br /> 818r2Qt1] <br />