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:y., � ,f;111!LVV 1`IUSVIOL'.1\ <br /> SANO Quit COUNTY j <br /> ENVIROf4M,NTAL HEALTH DEPARTMENT <br /> 344 E Weber Ave 3r4 Floor Stockton, CA 95205 <br /> vVY1468-3420 Fax: (209)464-0138 Web.vAvw.co.san-joaquinca.u&/ehd <br /> PIJ33LTC CORbS ULEASE APPLICATION <br /> _ <br /> APPLICANT: Z4,14 . B!J$INESSIAGEHCY: FIJ 6F6. <br />{ AbDRESS= <br /> PHONE 5 d / FACsiMiLE 209• $35-465 <br /> TE I FO�POINTMENT DATE: ASAE77me: g <br /> x <br /> (Please allow 70 business days from date of application submittal) <br /> fi6W 80X'TO ETEC ITE REQUEST-$91.60 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTDATE <br /> 00- — DepartrnentUse Only c <br /> T FILE ADDRESS UNIT 7 <br /> �. s Unit'f VVV <br />' 3, '&w 00ad.0 T G / Unh 2 , <br /> 2 950 L6091 VM 1 <br /> 2973 Z00&f'5 /oUnR3 ec 00 0 AZG'as� o <br /> S6. Sirce3 I . <br /> r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �ONDERGROUND TANK(UST)CLEANUP SITE(LOP},"OUSING ABATEMENT OL{A WASTE..- <br /> THER CLEANUP SITE(NON-LOP) FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MowrORINGIRE1410VAL} OG f�NNEl. �pA71iY <br /> P AZARDOU5 IKASTE GENERATOR CHICKEX RANCH EKG TREATME!!T PLAN i <br /> TIERED PERMITTED FACILITY ��F4TEUNdTEL9UMPERTAUCiUYARDICFfE[W rOILETS <br /> 13 TATTOOIBODY PIERCING �X POOLISPA `/f Wo USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> I.- List up to ten addresses In the space abov$- Select the type(s)of flies from the list abvye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0J38 or flail to.the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An'appolntment for review will be confirmed <br /> approximately five business days but no later than ten('i 0)days after receipt of application. The fifes <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 Immediately available fog review. A new <br /> applWation may be submitted when the file I$available. <br /> 4. Any file not returned in the"rne 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$93.00 deposit prior to review. <br /> S. *TENTATIVE appointment dates trust be confirmed with EHD staff, <br /> S. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME I <br /> PHONE FAX' 'INITIALS'.— <br /> DATE CONFIRMED <br /> RMEWED YES NO REVIEW DATE ` <br /> exn�s-azaas <br /> star$oes <br /> 3 ' <br />