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"9;/19/2005 12:56 FAX 209 948062 [1002/002 <br /> Ifl1nC �I \IL DD SAN JOAQUITi COUNTY <br /> ENVMQtj-VI.ENTAL HEA1TH DEPARTMENT <br /> SEF' 2005 304 E Weber Ave 3d Floor Stockton,CA 95205 <br /> 209) 468-3420 Fax, (209) 464-0138 Web: www-co.sau joaquiu.ca.us/ehd <br /> nE ( I <br /> ENVIRUNP„tN I HEALTH <br /> PEPAIMISEPVICES PUBLIC RECORDS BELE' ASE APPLICATION <br /> h L BUSINESSIAGENCY: <br /> 5'CoTo <br /> PHONE: <br /> t y S, FACSIMILE: <br /> ZA . F <br /> TENTATIVE'APPOINTMENT DATE: IDTime: <br /> {Please allow I0 business days from date of applicatlon subm'oaf) <br /> CHECK BOX TO EXPEOrfE REQUEST•MAO FEE-REUUEST PROCESSED IN a BUSINESS DAYS <br /> SIGNATURE OF APPLICANT p DATE <br /> -� Department Use DNy <br /> UNIT <br /> \ FILE ADDRESS <br /> I7-77 1 a ❑ Unit 1 <br /> S0 Unite )1 <br /> s1A AMXJnt E Unit �� <br /> 7. 7 w. <br /> Vv �`i 6. S� G P <br /> CLd Unil4 <br /> N e. I Ll. A'I <br /> S Ll P ❑ Un' 5 <br /> -a VR _. <br /> CASE <br /> ESTE FACILRY <br /> UNOERGROUNDTANKII- `, = �L-- -I-(�ly�,- % LSTE VEHICLE <br /> OTHER CLEANUP SITE[ �i�/ ( `Tllow <br /> ffi UNHAYARDOUS.WASTE Gf J:� Q\/n. A I ,GIJ� "�'-' .TRUGK/YAPTmeNT R�HEM TOILETS <br /> ❑ TIERED PERMRI ED FM - `} E APPLICATION SITES <br /> TATTOOlBOOY PIERCIN <br /> [7 MF <br /> OICAL WASTE FACIL _ <br /> the list above by checl ' 9 Aft <br /> 1. List up to tel -0138 or mail to t <br /> the appropri = <br /> address indi - ,w will be confirmed <br /> 2. EHD will no t of application. The files <br /> approximate should be scheduled <br /> will be held <br /> accordingly available for review. IV <br /> 3. A file that is - -- <br /> application by EHD staff at the exp <br /> 4, Any file not 3.00 deposit prior to review. <br /> of the appli <br /> 5. -TENTATN y <br /> 6. Application' - <br /> =CONF,.�F?hlt=,D•APP - ..,... _,:., <br /> 1'OQTEC�QNF1Rh1ED: . <br /> REVLEVIED YES NO REVIEW DATE <br />