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SEP- -2004 13:16 FROM:MICHEL%,,e 2092953974 464013E P:2/2 <br /> ENVIRONMENTAL L£AL� PAGFE 01 <br /> US/?1/2004 11:22 4540138 =ULVW 1'4VMn <br /> 13r <br /> T <br /> DATE RECEIVED SAN�lOAQUIN COUNW <br /> �, EN�V)RO1OWNTAL HEALTH DEFAki TMMN'T <br /> I Ff C�-,� 4 E U 304 E Weber,Ave P Floor Stockton,CA 95205 <br /> ,rin..aa us/ehd <br /> 21029p0468-342()Fax: (209)454- M Web:www-Golanlqqo <br /> j acl <br /> SEP tLTC TtECOk�DS tE A.S]E A-pr -.TCAL110N <br /> _ <br /> 1, sir <br /> APP[ICCH��� 1 S c. BUStNESSIAGENCY: <br /> vt d <br /> ADDRESS: 7 <br /> MORE: (zo 4 2 9 S-6 Z!fj _FAC31M1t.E: 9) <br /> I <br /> �0 <br /> TENTATIVWt <br /> E"APP +ITM <br /> EHT DATE: PT;MaJ <br /> (ply allow 10 busies 43P frOM dato of SppllMllon subMILI) <br /> CNF-CK BOX TO EXPEDITE REQUEST-$g3.00 FEE REnU"T PRWESSED IN a BUSINESS HAYS <br /> DA17- <br /> SIGNATURE OF APPLICANT , Oet>Mbnent Use OnlY <br /> UNrr <br /> ME ADDRESS <br /> C•>,, ❑ Unit 1 <br /> z ❑ Unit <br /> street ❑ Unit 3 <br /> j, Unit 4 <br /> a nit 5 <br /> a <br /> ,o. sheat • <br /> EWRONME TAL HEALTH pEPARTMENT FI <br /> n HOUSIt tG ABATEMENT CI <br /> s WASTe FACRXIY <br /> UNDERGROUND TANK(UST)CLEANUP SM(LOi) O POUs FAQ CI SbLD WASTE VEHICLE <br /> OTt(ERCLEANUP STM(NON-WP) c3 Doo%ENNEL C7 0kG T <br /> 0 UNDERGROONO TANK(MONTS�DRINGIREIKOVAL) Q CHICKEN RANCH Q PICC TREATMENT PLANT <br /> PER TRUCrJYARD1CHrtA <br /> E3HA7Jl,=US WASTE GENERATOR ❑ MOTEIMML R Pj�D USE APPLICATION W ES ET5 <br /> O TIERED PERMITTED FACILITY ❑ POOUSPA <br /> 0 TATTOOl130DY PIERCING n OTHER(PLEASE SPECI <br /> O NISPICAL WASTE FACILITYby checking <br /> Select the types)of tiles{tom the list AbOy' <br /> 1, List up to ten addresses n the sPace above- MUST be selected. ax o 09 a64-0138°t mail to <br /> es At least one file tYPe <br /> the appropriate box( )- <br /> d �Indicated above. mtment fo�review wall t�+a carlfirrnThe tiles <br /> 2 EHp will rjotify the apPl,cant if any EHD files e�dst. An appo' a,��Ipt of application. <br /> EH13apprill 110ely five business days but no later than t9n(10)days >;tttr�tents should be scheduled <br /> will be held for a maximUrn Of five business days for review. p►Ppo try avallable for review. A new <br /> accordingly. <br /> 3. A file that is activaty being worked oo a EHD staff may rtot,be imm d La jxed by l:H�staff at the ex nse <br /> application may be subenitted when the fila is available. <br /> 4. <br /> Any file not returned in the same condition as Te1eQ Win!may qtr,a$93-00 deposit prior to reviev► <br /> of the applicant. Future the review's by ed with F-HD staff- <br /> s. 'TENTATIVE appointment dates must <br /> conran <br /> 6. <br /> Applications receWpd atter 3:40 pm will be processed thv next busin day. <br /> TIME <br /> CONFIRME=D ApPCl1NTMENT DALE <br /> PHONE; FAX <br /> pAT6 CONFIRMED REYl1=1Ai DATE <br /> REVIEWED YES NO <br /> aenocs <br /> �. l <br /> P. 2 <br /> AUG-37,^�J04 TUE 09:39 TEL-.2e92953974 NAME: <br /> t1ICHELSON <br />