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12/03/2003 09:09 CLQ '-ON GROUP 4 12094640138 NO.404 G <br /> --- PaCzE E1 <br /> 11/20/2003 12:50 4640138 ENVIRONMENTAL hu -TM <br /> tHU LUV UUIWDr—I: <br /> OATc r SAN JOAQUIN COUNTY <br /> Ll-� <br /> Eh '-zROIY1vIENTAx,HEALTH DEPARTMEN?' <br /> DEC Q ?00� 304 E Weber Avc 3r' Floor Stockton, CA 95205 <br /> �a u,,lehd <br /> (209) 468-3420 Fax. (.09) <br /> 464-013$ tiVeb: ,Nww.ca.san joaq <br /> ENVInUNm,ENT HL�LI11 �AS1L APPLICATION <br /> PERI,I'Ii7!SERVICES p JB ,T.0 RECONS' 1100> <br /> 6USINESSIAGENCY: �j <br /> APPLICANT=g <br /> ( t7 <br /> Y- y�LrW�,, t/I � <br /> A�oRESS: t jt' oO l of 2.5 �126 _alob <br /> c "�6 -'Rbgo FACSIMILE', <br /> PHONE: I Time: <br /> YKNTATIVF APPOINTMENT DATA: licetlan submittal) <br /> (plea-so allow to bu91n039 data rrvm data of app <br /> �xpEfl(TE RgnUL3T• .00 FEE-REQUEST PR s EO IN 5U51i4p$5 DAYS <br /> CHFCK a0x To _ DATE <br /> ' p�partr»ent Use Oniv <br /> SIGNATURE OF APPLICANT ..., <br /> uNtT <br /> FILE ACURESS rV ❑ Unit 1 <br /> Cat <br /> zvoc+ 125 a 5 <br /> [] Unit <br /> t, s>«c u <br /> Unit. <br /> e, sncM cn t <br /> 7 SI,a Cl I Unit 5 <br /> 9 51 m G <br /> st U� <br /> 10. So-ao <br /> ENVIRONMENTAL HEALTH QEFA5TMENT FILES <br /> d Hou3ING ABATEMEKY d St3L(0 WASTE FAGtUTY <br /> O SOLIO WASTE VrHICLE <br /> VHAZARQOi,� <br /> NRERGKOUND TANK NST)CLEANUP SITE(LOF) F 00 FACILITY ❑ DA0 <br /> THER CLEANUP SITE(NON-LAP) n f 0 KrNHEL Q PK0 TREATMENT PLANT <br /> jC <br /> NDERGROUND TANK(MONITOKINGIRErAOVAL) CHICKEN RANCH D PUMPER TRjCWYAROfCHEM TOILETS <br /> YVA5�GENERATOR p mo mu'mOTEL p o U5E APPLICATION 51Ta <br /> HAZARD PERM FACILITY 0 FOOLISPA , <br /> p TATTOO)800Y PIERCING �'o7HER(PLEASE$Pt Clf"Y) checkin <br /> ❑ MEDICALWASTE FACILITY of files from the fist above by <br /> ace abovo. select the�type(a) �ts4-11138 Or mail to t e <br /> 1. List up to tan addresses In the <br /> tale type mijST be selected. Fax o 209 <br /> the appropriate bcx(as), <br /> address indicated ahove. ointment for review will ber The rle: <br /> EN4 will notify the applicant if any FHO files exist. An app s after receipt of application- <br /> Z' fiv®buslnes5 days but no lator than ten �1Q) day ointments should be Scheduled <br /> approximately for review. APP <br /> will be held for a maximum of five business days not be Immediately available for review, A n <br /> accordingly worked on by EHD staff maY <br /> 3 A fele that is aeti be being �nized by END staff at the exp <br /> er <br /> appl{cation may be submitted when the file is available. <br /> the same applicant may requiir® a$93.00 deposit prior to nevi <br /> Any file not returned in the same condition as r®leased will be re <br /> of the applicant. Future file reviews by with 1=Hess day. <br /> 0 staff. <br /> 5 apceived after 3:pointment dates must be confirmed <br /> g Applications re pm will be processed the next busin <br /> r1 ENTAT{YE <br /> TIME <br /> CONFIRMED ApFolti`tMENT OATS INITIALS <br /> PHONE FAX <br /> OATS CONFIRMED RIEVIF-W pATf= <br /> REV(�WED <br /> YES NO <br />