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r.; Z002 V <br /> 10128/2004 13:24 FAX 209 9480 MMLI L.VV A NVMVV,+ <br /> D RECEIVED v.r SAN JOAQUJN COUNTY `..� <br /> ENVfRONMENT.A.L HEALTH DEPARTMENT <br /> 304 E Weber Ave 3"1 Floor Stockton,CA 95205 <br /> (209) 458-3420 Fax: (209)454-0138 Web:W,*W.co.san joaquin•ca-uduhd <br /> PUBLIC TECO"S MLEA.SE AyPLICA'YTION <br /> APPIJGAN'T- <br /> t r�Si.h BUStNESSIAGENCY: <br /> ��Y' <br /> ADDRESS: <br /> PHONE: �� ci '13t� FACSIMILE: O� 44a <br /> TENTATW APPOINTMENT DAM W 46A Time. a– <br /> (ptoase allow 10 business days from data of application submittal) <br /> CHECK SOX TO EXpenrM REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 <br /> BUSINESS DAYS I al b <br /> DATE 1 <br /> SIGNATURE Off APPLICANT — Department UsaOnty <br /> UNIT <br /> FILE ADDRESS , <br /> :.fid ❑ Unit 1 <br /> G k �%.1 ,�� � 9;,r�,,Unit <br /> q N.W+tSw�. 1i `i" € . ',;�., +y„r mac•• �\0 <br /> . Ltv •o a k U4 ,�fll;1 '' Unit 3 \ <br /> s. L►oo G S�: '"� �:' Untt4 <br /> sued t ''!'fl � A j¢=";�•• '- 0 Unit 5 <br /> w � �M • <br /> -ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ABATEMENT 1m soLlo WASTE FACILrrY <br /> SA UNDERGROUND TANK(UST)CLEANUP SITE(t ❑ HOUSING <br /> .op) d FOOD ASTM ❑ soUD W STE VEHICLE , <br /> a OTHER CLEANUP SrM(NON-LOP) ig DAIRY <br /> IA UNd DOG KENNELDERGROUND TANK(MONITOR1NGIREMOVAL) 1i�.PKG TREATMENT PLAM <br /> O CHICKEN RANCH CPUMPERT � <br /> TS <br /> � � E <br /> rg K471RDOUS WASTE GENeRATOR ❑ MOTEL HOTF_t, Cil.. LAND USE APPLICATION SITES <br /> a TIERED PERMRTED FACILITY OpooLISPA <br /> ❑ TATTOOMODY PIERCING ❑ OTHER(PLEASE SPe;GFY1 <br /> ❑ MEDICAL,WASTE FACILITY checking <br /> to ten addresses in the space above. Select the types)of files from the list above by <br /> 1. up a MUST be selected. Fax to 209 46.4-0138 or mail to the <br /> the appropriate box(es). At least one file type <br /> Address indicated above. ointment for review will be confirmed <br /> 2, EMD will notify the applicant if any EHD files exist An app <br /> approximately five business days but in later for an ereview.Appointments shoulays after receipt Of d be scheduled The files <br /> will be held for a maximum of five bus <br /> accordingly. not be immediately available for review. A ne,h <br /> ' 3, A file that is actively being worked on by EHD staff may <br /> application may be submitted when the file is available. by EHD at the exP <br /> will be <br /> q. Any file not returned in the same Condition the same applicaas releaSed nt may requireZa$93.00 deposit prior to ev view <br /> of the applicant. Future filo reviews y <br /> 5, 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> ed the next business day. <br /> 6. Applications received after 3:00 pm will be proces s <br /> •P <br /> t=D i4PP�tN71VlNTAT� <br /> PHONE <br /> i- t: FAX'" <br /> :DP.TE-GONt=IRIVIED <br /> >. YES NO REVIEw DATE. <br /> REVIEWED <br /> • UM 4442a06 - <br /> snV200a <br /> � A . <br />