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f <br /> fipr '29 04 02: 27p-- -RZFIN & 'f1SSOCIATES 91r^564 2222 p. 2 <br /> EMIIRI NfAL HE S VAUL Eli82%05/2004 12:12 4640 _ env w�a� <br /> c > a SAN JOAQUIN COUNTY <br /> 4 I� �f L`�D ENVIRONMENTAL BEALTH DE ARTNW T <br /> 304 E Webc>•Ave 3 SOOT Stockton, <br /> CA APR 2 9 Z0R6)468-3420 Fax:{2,09)464-013B Web:www.cosaan joaquin.ca usTchd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RM,,FASE APPLICATION <br /> V '. � i BU9Cdl:SS1AGI:NCY� . <br /> APPLICANT. ,meq Q <br /> ADORLISS, �"O <br /> FAC3[MiLF: <br /> TWO. s <br /> TENTATIVE*AMOINTM14T DAZE: <br /> (please allow 101buslnaz days*W^date or apprC&tWn sy6mlttal) <br /> XCHECK BOX TO EXPEDITI:REQUEST <br /> 0 FTE <br /> EST PROGESSED IN 3 g1J$lNEsS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT Ooaartrt+en!Ilse OrIN <br /> UNIT <br /> FILE ADDRESS ' { • Unit 1 <br /> �` A ai <br /> ,. <br /> 7 cY 4 . unit 2 <br /> /y 'U Unit 3 �J <br /> A. C <br /> _ �a <br /> Unit <br /> Unit 5 <br /> f. Sues, <br /> ENT FILES' <br /> ENVIRONMENTAL 14EALTFt DEPARTM � ��' <br /> 13 NCUSl11C AgAitalAEl�T AD(SQLIO WASTE FAGtLM <br /> VAIRY <br /> UlIDERGROUND TANK(U5 n CLEANUP S1W(L' O FOOD FAC%M a SOLRY�nf0�9TE VEHICLE <br /> OTHER CLEAMW SITE(WON-LOP) p DOG!(ENNEt 4 PIKG <br /> 11lTORlNGrREMov+o i ❑ p1fG TREATMENT PLANT TOILETS <br /> O MT <br /> N13ERGROUND TANK(HI � CHICKEN RANCH O PUtIPER TRUCKIYAROICtil= <br /> rO3HAZARDOUS WASTE 6ENERATaR O MDTk1JH4r1=L ❑ LAND USE APPLfGAT10N SSTE9 Y <br /> TIERED pERM TTED FACILITY n POOLISPA <br /> Tl1TTOQl MY PIERCING 13 OTHER(PLE"s SpeCII=Y) <br /> MEDICAL WASTE FACILITY checking <br /> t, List up to ten addresses in the�spac9 above. SeieCt the types)of tiles from the list above by <br /> the appropriate bvx(es). At least one file tVP9 MUST be selectrd. ax o 209 <br /> q84-Q138 or mail to b <br /> address ndlcated at�a�e. y ointment for review <br /> of all be application. he(lies <br /> 2• EHD will notify the applicant if Y EHD flies sxisL Art appays ointment <br /> recslp Pp <br /> epp i y five business days but no iatOr than ten vd Appointments should be schaduted <br /> yip be field for a rn2X1MUtn W five business days f Y available for review. Anew <br /> accordingly worked on by EHD staff may not.be ismnediatety <br /> 3. A file that is actively being enso <br /> application may be submitted the ails N available. EHD staff at the exp <br /> Meant WAY require a$93.00 deposit prior to review. <br /> 4. Any life not returned in the sax;ne c'by the same app as d will be reorganized y <br /> of the applicant. Future file review's Y EH <br /> 5. 'TENTATIVE appolntment dates mm wist ll be processed ed the next business day. �^V <br /> 6. Applications tocelved after 3:00 P <br /> TIME <br /> CONFIRMED ARPOINTMENT DATE <br /> PHONE . FAX' IN1TlAL5 <br /> DATE CONFIRMED REVIEW DATE <br /> REVIEWED YES Nt3 . <br /> i <br />