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'),kN jOAQUIN"COUNTY <br /> DATE REcEIYED, <br /> TAL RRA NLT1_1 DEP t <br /> 1 ""J2 ENVIRON?40 cP,952027()S <br /> Sjg0v <br /> St. sto ckto, or <br /> 600 East Mal' <br /> Fay. ('209)464-0139 Wcb' <br /> -3420 <br /> (2()9)469 44 <br /> T, I App'LJCAAW <br /> 'ECO"SLEI NSLA <br /> "E' <br /> PuBLIC R Stj Sl NES S1 AGENCY' <br /> _J� Vj J%A, CITY IST ATEfzlp <br /> APPLICANT: D C FACSIMILE: <br /> ADDRESS: PHONE t2): r Time: <br /> -must beconfirmed) <br /> ntative Only <br /> PHONE M: APPOINTMENT DATE: bmittal IjSINESs DAYS <br /> TENTATIVE* business days from date If application Su. T PROCESSED 114 3r <br /> also allow 10 bus R CHECj(Olqi_y)'�REQUES <br /> (pie 'I <br /> jD5 oo FEE(CASH 0 <br /> To EXPEDITE REQUEST DATE <br /> 0 CHECK BOX <br /> SIGNATURE OF APPLICANT <br /> --- unit I <br /> Electronic Inform ----------------- <br /> List map—Description' EHpUSE ONLY <br /> Information: El <br /> F LE ADDRESS city <br /> Street Name Unit 2 <br /> street# <br /> tj it 3 <br /> 2. <br /> Unit <br /> 4. <br /> 5. ❑ unit 5 <br /> 6. <br /> 7. ❑ unit 6 <br /> 10. <br /> Information Requested: From <br /> TME NT FILES <br /> specific Date Rang <br /> e of Inforrn ENVIRONMENTAL HEALTH DF 0 SOLID WASTE FAC IL'IlyfVENICLE <br /> CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 WASTE TIRE <br /> C3 FOOD 0 DAIRY _r PLANT <br /> UNDERGROUND TANK(UST)CLE 0 WASTEVVAT ERTRFATIAeN TOILETS <br /> $ITF(NON-LOP) 13 DOG KENNEL <br /> 0 OTHER CLEANUP 0 PUMPER TRUCK�ARDICHEM <br /> ,XebNOERGROUND TANK WONTORINGIREmOVAL) [3 C"ICKEN RANCH APPLICATION SITES <br /> [3 MOTELIHOTEL [].LAND USE <br /> 0 HAZARDOUS WASTE GENERATOR0 POOLISPA <br /> TtERF <br /> PERMITTED FACILITY <br /> OTHER(PLEASE SPECIFY) EXCLUDING HOLIDAYS. <br /> Y PIERCING <br /> [3 TATTOO113011) . M0N;AY-FRIDAY 8:00 AM-5 00PMrp nate <br /> MEDIGAI EFACILITY �R RF_%AEyy <br /> W AST ROT RECORDS All AvAll-ABLE Ill <br /> &R. the type(s) of files frOtil the list above by C111 _ above, Address <br /> WELL AND SEPTIC PF above. Select .0 the address indicatedelved after <br /> 71011 4r,4_0j 38 or-rn ail I t I ---.--licatj ons received <br /> n the s ace b 1. D.APP <br /> Lis t ten addresses I e P ST be selected. addresses','contact the Il <br /> t one file type <br /> MU tionai assistance with tile ad <br /> List <br /> =as � di approxirnately ten <br /> box(es)- epted-for ad rmed <br /> ranges'mill not be a0c the next business day. tent for review wrill be COnfil .ew. APP <br /> o7intments <br /> 3.00 pm Wit be Processed .any Ell flies exist. An apPOlntrT of five businesfo <br /> days for revt <br /> The EHD will notify the applicant'It files will be held for a maximum tion may b, <br /> 2. days after receipt of app lication. The 'tabler review. Anew aPPliGa <br /> should be scheduled accordingly. n by F-HD staff May not be iM'mediate i ly available <br /> that is actively being worked o staff at the expense of the applicant <br /> 3. A file t1 available. "D <br /> submitted when the file is orqaniz�d by E <br /> not returned in the sarne condition ;is released will be e .,P,,,,prior to review, <br /> 4. Any file h.samea-pplicant may require a$J05.00 d <br /> file reviews by t FVjD USE ONLY directly. Tijank You <br /> Future I �---t -[)�jane —(209)468-342! <br /> --------� jell contact <br /> need further assistance <br />