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03!26PM <br /> -77�- <br /> SAN JOAQUIN COUNTYpUBUC HEALTH SERIVICF-s <br /> VIR <br /> ,ONMENTAL HEALTH DIVISION <br /> EN MIRD FLOOR <br /> �[B Z 6 ZOO' 304 EASTWEBERAVENUEi <br /> S-COCKTON CA 95202 <br /> HP LTH (20%4rog-3420 <br /> F-I-EASE APPLIGATi0N <br /> C j,Q, F�,q ICES <br /> PLJBL.IC RECORDS R! <br /> ADVOSS <br /> PHONF. FACSIMILE <br /> Vr-?b,kk- <br /> APPO'NT -y t) <br /> MENA frogo date of 1ppllc4tlan itik"Ittxi) <br /> (please give 7 to 10 busi'M023 <br /> a FEE CHECK BOX TO EXPEDITF RE dUCS7 SB7 F_r_REQUEST PROCESSED IN 3 B"'NESS UOI'YS U),ATF <br /> 5IGNATURF.OF APPLICANT <br /> SIDE F"D STAFF USE ONLY <br /> FILE ADD RES S PRgCiitAWl ELEM4" <br /> 2– + Ga o k 352-7 <br /> z-7 <br /> 33Ca. .s+ <br /> 3�5, <br /> t-�LL S-r- <br /> Ft-, a*4 ISION PILES <br /> ENVIRONMENTAL ALTH D1 <br /> 0 SOLID WASTE FACIUTY <br /> LAANUF$I'FE(1-09) o HOUSING ABATF-MF-NT 0 5 OLID WAST9 vF-H ME <br /> .,16 GROUND TANK(UST)C In Fom FAMIly 0 "Ry <br /> 0 OTHER CLEANUP SITE(T10N-LOPI) GfREMOVAL) 0 00a KF-NNEL 0 PKG TREATMENT PLANT S <br /> 0 Li No M- 13110IJ NO TANK NONITCiR'N n ClAtGKEN RANCH 0 putApeft TrLUCKNAROM149M TOILETS <br /> C <br /> U140TEL In LA"D U.Sf.APPL-MATION BrMs <br /> IAAZAR,pC)uS wA.STE GENERATOR 0 MCF�F <br /> TIERED pERMITTED FACtu VY C, POOLJSPA <br /> 0 TATTO(IJU00-Y P-EIRCiNG ptjj3LtC WATER SYSTEM 0 OTKER(PLEASE SPECIFY ABOVE) <br /> MEDICAL WASTE r-A-C'L'Ty ove by checking <br /> Vt,. Select the WOW Qj files tram the list ab VL—Maal–to–ft <br /> List UP to ten addresses in the space abO Ej,to Zo 64-0� <br /> UST be selected.. �4 38 <br /> t"appropriate box(es)- At je2Zt one file tYPe M ove, ointment for reViOW Will 13D Co'n"ned <br /> Ad96-iz�'lnc� if any E141D files exist. An2p, <br /> p :jFy the applicant <br /> HD Will not later then ten(I 0j days after receipt Of application. 'The files <br /> �jy five days but no <br /> approximat( review. AppOintments should be scheduled <br /> will be held for a m"ximuM Of five business days for immediately available for reView. Anew <br /> 2ccordingly,actively woLrkad on by EHD Staff may not be il%iMe <br /> 3. A Me that is may b4,submitted when the file Is avail2ble- aanizOd by EHV Staff at the expense <br /> application a same condition&3 relaar,6d,wiii be reorl <br /> 4- Any file not returnee In th kpPlicant rn ay r,equire a$97.00 deposit prior to review. <br /> of the app,lcant. Future lite rcv;gW&by 1132 SaTn* h F-1-113 stiff, <br /> n-sur <br /> .t bt 4;4nfiryned wit <br /> 5. TENTATIVF appointment dates the next boSiness day. <br /> r3. <br /> 61 Applioltions received afte .00 prn wilk be processed ------- <br /> TIME <br /> CONFIRMED APpOINTMENT DATE <br /> I <br /> pHONE PAX NITIAL$ <br /> I OATC GC)Nr-IRMF-D <br /> YESNo REvIEW DATE <br /> _� <br /> TOTAL P-02 <br /> P,E _1��E �ED�Vd� <br />