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04/05/2005 16:17 FAX 209 948r _ ZO02 <br /> _i�, ��D,1i11 f Jti C.11L V4V IIV I�INu♦ <br /> SAN J�oAQTTLI�{ Comic <br /> ENvzxoNmErTAz.H'ALTH DEPARTMENT <br /> ' R 304 E Weber Ave 3`1 Floor Stockton, CA 95205 <br /> ENV',F;tcj'W,A1.B!T HW)468-3420 Fax; (209) 464-0138 Web: www-rc.sazz joaqu1a-mus/ebd U <br /> PErojg/I,ERtifI .FSS <br /> PUBLIC PTCQTDS RELEASE A.PPLZCATXQN <br /> APFUCAdfT. <3USINESSlAGENCY; <br /> A004ESS- - : <br /> PHONE: ` FACSIMILE: ^ <br /> t <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> l <br /> (please allow iG business days from date of application submitial) <br /> u CHECK EOL(TO EXPeDfrE FUdQUEST-$92.00 FEE-REQUEST PROCESSF-13 IN]BU51NE5S DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Devarknent Use ONy ' <br /> i <br /> UNIT <br /> LE ADDRESS <br /> FI <br /> f2 <br /> Z <br /> Unit nit <br /> i &C, o''r ❑ <br /> i <br /> � ) <br /> ty <br /> i. sant tn <br /> Unit <br /> %rte <br /> saw Unit 3 <br /> z�rle surd a Unit 4 <br /> e. sem+ ❑ Unit 5 <br /> i <br /> 1/A I E <br /> -ENVIRONMENTAL HEALTH FILES <br /> DEPARTMENT FIL �___ � ►.-c-jS—r� <br /> WASTE FACIUN <br /> t� I INDERGROUND'TANK(UST)CLF-ANUP SITE fI-QF1 13 HOUSING ABATEMENT SOUID WAS �- <br /> E OTHER CLEANUP UM(NONE OPI 13 F00 FACILfTY 17 SOLID WASTE VEHICLE <br /> W, UNDERGROUND TANK(MONITORINGrRSMOVAL) 0 OOG KENNELAW <br /> L. DAIRY I <br /> CI CHICxEN RANCH 0-PKG TREATMENT P -C` V 4 <br /> Z KAZARnOiIS WASTE GENERATOR d MOTl;LIHOTEL E7 PQMPERTRUCK1YAlRDIGHEM TbLM Y � <br /> Q TIERED Pt=RMr�TEi3 PACiLfTY ❑ pOpL.fSPA UL t_ANI)USI-APPLICATIONS S , G; <br /> ❑ TA17d4BaoY PIERCING OTHEf2(pLPASE SPECIFY) <br /> CI MEDICAJ,WA5TE FACILrry y� <br /> �- List up to Een addresses in the space aklove. Select the types) of files from the list above 1?y eheciking <br /> the appropriate boxes). At least one file type MUST be selected. Fax t❑ 209 46d-0138 or mail to the <br /> address indicated above. <br /> 2- EH❑will notify the applicant if any EHD files exist" An appointment for review will be confirmed <br /> approxirnately five business days but no later than ten (10) days after receipt of application. The files <br /> will be held for a maximUM of five lousiness days for rev nw. Appointments should he scheduled <br /> accordingly. f <br /> 3. A file that is actively being worked on by EHD staff may not be imri'lediately available for review• ner i <br /> application may be submitted when the Fite is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expen$'' <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to revie� <br /> 5. 'TENTATIVE appointment dates trust be confirmed with EHD staff. <br /> fi. Applications recelved after 3:00 pm wilt be processed the next'business day. <br /> --C' N R E <br /> TIME :'''`���-,'.LLQ.,_,,_.. .� :•3':�'<._.�,. , <br /> 4 iui p'A rlriviF-NT r <br /> r:PHONE . FAXkA1=5 <br /> F.•. <br /> FDATir.GaNFI{�MsrD <br /> REVIEWED YES NO REVIEY`! DATE' <br /> FHn aa�x-0ae <br /> 1r <br />