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EMD LOG NUMBER. <br /> D SAN JOA.QUIN (;oTJN�'Y <br /> Arm <br /> IV U LVxv.oNnjEN AL HY-ALTH J)EPARTMENT <br /> �� 3 <br /> MAR 1. 3 2006 <br /> 304 E Wcbe�'Ave 3 Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209) �464-0138 Web: vuww.co.san,-joaquizr.ca.us/ehd <br /> ENVIRRIMENT HEALTH <br /> PERMITISERVICES PUBLIC RFCORDS REUF.A.SE APPLICATION <br /> n� gU51NESS1AGI=NCY: <br /> APPLICANT: C. <br /> ADD REss <br /> PHONE: , 'J[VSIO FACSIMILE: <br /> TEI+ITA`f IVE"APPOINTMENT DATE: <br /> Splease allow 10 business days from data of application submittal} <br /> © CHECK BOX TO EXPEDITE,REQUEST- 9340 FEE—REQUEST PRQCESSEP IN 3 BUSiNE58 DAYS <br /> SIGNATURE-OF APPLICANT; -- V <br /> � ou DATE <br /> Department Use Only <br /> UNIT <br /> FILE ADORE SS.. <br /> 01 A Unit 1 <br /> ' /� ti <br /> 3. 5Sracl p r4A CIl ❑- IJr11t <br /> `- / <br /> Cit e <br /> ' J <br /> I 4. SUeel tC/ i i i � <br /> 5. Slant Ci � Unit <br /> r 6. sheet � Ian - / <br /> 7, S[reet Cf ,y� <br /> G1 lJ <br /> 9, Slreei <br /> 01 o Unit 5 <br /> 9, utreBl <br /> CI <br /> /0, 31ree+ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACiLrry <br /> VUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FoQD FACILITY C3 SOLiD WASTE VF-HiCLE <br /> W OTHER CLEANUP SITE IKON-LOP} p DOG KENNEL T.7 DAJRY <br /> Ne UNDERGROUND TANK(MON ITORINGMEM OVAL) 0 CHICKEN RANCH 13PKG TREATMENT PLANT <br /> A7AFtD0U5 WASTE CaEivERATOR MpTEHQTI:I. 0 PUMT'Eft TRUCKfYARDICHEM TOILETS <br /> ❑ <br /> t� Ti> RED PERiVIIT iED FACILITY 0 OOi UHOSPA: ❑ LAND USI;APPLICATION SITES <br /> 0 TA•iT001BODY PIERCING C3 OTHER(PLEASE SFECIM <br /> C3 MEDICALWASTE FACILITY <br /> 7. <br /> List Up 4o ten addresses in the space above. Solbot MUSTbeselected f Fax toriles o 209 464 0138 or ryal to they <br /> UST <br /> the appropriate box(es). At least one file typ <br /> address indicated above. onfirmed <br /> 2• Elia will notify the applicant If any EHD files exist. An appointment for review will be c <br /> approximately five business days but no later than ten (10) days after <br /> r co should li tion.cheiledThe files <br /> will behold for a maximum of five business days for review. App <br /> accordingly. <br /> 3,. A file that is actively being worked on by F-HD staff may not be immediately avaitable for review, Anew <br /> application may be submitted when the file is avallable. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> s by the same applicant may requfre a $93.00 deposit prior to review• <br /> of the applicant.`Future file review <br /> 5. , *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> i 6. Applications received after 3:00 pm wilt be processed the next buslness.day. <br /> 713ATE <br /> RMED APPOINTMENT DATE <br /> TIME <br /> 1 PHONE FAX INITIALS <br /> I ONFIRME[7ED YES NO REVIEW MATE <br /> 1EFSpne.ozfi0n ., - - - <br /> wareno3 <br />