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t ` r-tio LUG Numbtfk <br /> rf QTS RECEIVED SAN,J OAQUIN COUNTX •• _ ^ <br /> 304 Weber Ave 31d Floor Stockton, CA 95205 1 <br /> R wvr <br /> A {2 68-3420 Fax., (209)464-0138 Web: w _co•saxi joat�uin.ca.uslehd <br /> c� <br /> On s <br /> SCO"S RELE,ASF, APPLICATION <br /> Japp' <br /> 4- �r v SUSINEs9IAGENCY: <br /> APPLI <br /> ADDRESS: 17 -7 <br /> 3�0 FACSIMILE: <br /> PHONE: <br /> T9NTATIVE"APPOINTMENT DATE: <br /> C1�..� �-'� U � Time: / _0_y <br /> (Please allow 10 btlsiness days front date of application subCnit@ai) <br /> El CHECK SOX TO EXPEOITE REQUES _$93 9 REQUEST PROCESSED IN 3 OU51t4rtSS DAYS a <br /> DATE Gd f!� <br /> SIGNATURE OF APPLICANT ' bepaartment Use Only <br /> UNIT <br /> FILE ADDReS$ <br /> df. G1 a L7 unit i <br /> 1'1'l <br /> Q cl <br /> 7. StreM G t 1 <br /> 1, sire-el - l�rtft 2 �VJ <br /> 4, Street G (�� <br /> ci Unit 3 <br /> s. strw <br /> Gl <br /> S. 3dEe1 <br /> � nit <br /> t. <trent <br /> a, suaet <br /> cal <br /> J Unit 5 <br /> 9. Srr4A <br /> 10, Sliest <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I/UNDERGROUND TANK(UST)CLEANUP sITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE VEHFACICLE <br /> 15�OTHER CLEANUP SITE(NON-LOP) ❑ F09D FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(moRITORINGIREMOVAL) ❑ DOG KENNEL ❑ PI(G T <br /> l3 ATJARDOUS WASTE Gi NERAYOR ❑ CH1r_KF_N RANCH ❑ P1CG TREATMENT PLANT <br /> Gd TiEFiED FI~RNiiTTI D FACILrfY 0 MOTFUMOTEI_ ❑ PUMPER TRUCKIYARDICHi=M TOII��tS <br /> C7 TA'1'ro0160I3Y PIERCING O POOLISPA M LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> List Up to ten addresses in the space alcove. Select the type(s)of files from the list'aboye by checking <br /> the appropriate box(es). At feast one file type MUST be selected. Fax fb 209 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for'Teview will be confirmed <br /> approximately five business days but no later than ten (10)days aftar receipt of application—The files <br /> will be held for a maximum of five business days for review. Appointments Should be scheduled <br /> accordingly. - <br /> 3. A file that is actively being worked on by EHD staff May not be immodiateiy available far review. A new <br /> application may be submitted when the file is available. <br /> 4, Any file not returned in the sam6 condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require'a $83.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates Must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business.day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAXINITIALS <br /> REVIEWED YES' NO REVIEW DATE <br /> EHD d8-02.Oad - <br /> h a18Y10a9 . <br />