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01/14/2005 09:46 FAX 209 948 t 0002/002 <br /> / RECEIVED <br /> SAN JOAQUIN COUNTY <br /> 4COWED 1E O"LENTAL REALTEE DEPAPLTNI.ENT <br /> 304 E Weber Ave 3rd Floor Stockton;CA 95205 <br /> °t;a� j 4(����468-3420 Fax: (209)464-01381VS�eb:wwtiY.co.san joaqukL caus/cktd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS PELEA.SE AI?PLICAnON <br /> APPLICANT, f�.w �'�(b .fa BUSINESSIAGENCY: tti' i111'F-erir <br /> ADDRESS: -dz a5 4_1A Rios <br /> PHONE: FACSIMILE: -0&oay " <br /> TENTATM*APPOINTMENT DATE: 29/0. Time: 1oZ:ao <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-S93,00 FEE—REQUEST PROCESSED IN 3 BU$INESS DAYS 1 <br /> SIGNATURE OF APPLICANT ✓.•r. �,' DATE I lot�- <br /> ent <br /> Use Only <br /> FILE ADDRESS UNIT <br /> t_ S,, -da a %azcx Unit 1 <br /> a. sv�4 r- 'e 't, 'blvd CRYn r unit?, V <br /> lQ�° <br /> 4. so Go ' _-�' <br /> s. s&..a " I� <br /> s, sNcn 1-o Itw aty .7 t <br /> r. sv v to / m Unit 4 <br /> e. saw City <br /> 9, SUee{ ❑ Unit 5 <br /> �o. soed -0ty <br /> ENVIRONMENTAL HEALTH DEPARTMENT FINS Vp <br /> UNDERGROUND TANK(UST)CLEANUP SFM(LOP) ❑ HOUSING ABATEMENT Ut.SOLID WAS ILITY <br /> OTHER CLEANUP SITE(NON4-OP) <br /> ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> IS- UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG K1=NN1 tilt DAIRY <br /> ffi HAZARDOUS WASTE GENERATOR d CHIGXV-N RANCH 19-PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ pumpER TRUCK/YARDlCHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOUSPA In LAND USF APPLICATION Sri'ES <br /> Cl MEDICAL WASTE FACILITY d OTHER(PLEASE SPECIFY <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the <br /> address.indicated above_ <br /> 2. EHO will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10) days after 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 immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same 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 /> 5. "TENTATNE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm Will-be processed the next business day, <br /> 'CQ.I`IFI,f�M�D A.F'POINTNIENT�[)'A'f�; `� !,.; :�,' r::.-�_••'�• -••T1M1 ::'�•::v. � _��:`'::::.' •. , <br /> :DATE C.aNF1RME4 IPHbNE . FAX" :;x'-= iNtL1ALS' -;<Y•' <br /> :.I r' <br /> EtEVIEkVED YES NO REVIEW DATE, <br /> EHo 48-024ac <br />