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/4-2005 ' 11:11 CONDOR EARTH TECH �1 209 532 0773 H.b1/I7: <br /> a <br /> F <br /> RECEIVED �IQ LOG NUN Z <br /> SArr JOAQUIN COUNTY i <br /> `` U E�l"V?fmONMEId'I'AL LTH DEFARTMEN�' <br /> -ACE <br /> 3VED 304 E Weber Ave 3 Floor Stockton, CA.95205 <br /> } 7005(209)468-3420 Fax= (209) 46"138 Web:www.co.san-joaquinmus/ehd <br /> IYE N NMENT HEALTH PUBIAC RECORDS REEEA.SE APPLICATION h <br /> NEEP =AM <br /> 1�1 �i'aAPPLC StJSi>�iES51AGISJCY: - _ <br /> ADDRESS- R, Q. <br /> PHONt F,4Cs1lYlll>~ <br /> 05` T1�ne: o a. vn <br /> TE.NfATNE"APPOIN'YMENT DATT: .: �,. <br /> $ase altm 10 bu9lneas dao from date of appftwon Buhmttial) % i <br /> CHECK BOX TO Evwft>E ItEQugs-r-$nen rn-ItEQUE57 PROCESSED IN 3 8USW=S$DAYS <br /> EIGNATURE by APPLICANT DATE l�' '� <br /> Departmsmt Use Only <br /> FLE ADDP S3 UNCr <br /> i. ,P dT F QI'Q[fCTd+U TRLOO El Unit 1 <br /> s &rel 10042- F-1 OdM 10CK F <br /> 3. Shot 1041,5- E• ERLOQ - �UnI�2 <br /> 4. s..,A F' ZZI I?A• I 35Q& <br /> ';� <br /> a s�.es 7 Sts P + A. CRI AA F Unit 3 }1 <br /> ,_ serer S7oICKTpNTbRMINAir+ sTeRN ew perunli:4 <br /> 10. Blreet I <br /> EWRONMENTAL,HEALTH DEPARTMENT FILES �VnI <br /> Lo <br /> UNDERGROUND TANK(U"CLEANUP 5rrE(LOP) 0 HOUSRIG ABA'iEMENT �SOLJD WAM PACILrIY <br /> OTHER CUMUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID <br /> WASTEVEHICLE <br /> uClB <br /> UNDERGROUND TANK(MONITORINGfREMOVAL) P DW KENNEL �pr-sDAMY <br /> HAZARDOUS WASTE GENtUMrOR X CHICKEN RANCH O PUMTRFJ�TMENTALANT <br /> Tn=sr+=n PERMITTED FACWTY ❑ MOTELIH(YTEI. �PUMpERTRILCKlYARA Id 7gILET, i <br /> R rEREDTATTCHPERMI All D FA 1] POOLlSPA LAPM USE APPLICATION SMS Y <br /> ❑ MEDICAL WASTE FAGIL 1TY Q OTHER(PLEASE SPECIFY} <br /> d <br /> s of tiles from the:list abOYO try checlr <br /> 1. L:I#t up to ton addresses in the spade alcove. Select the types ) <br /> the appropriate box(es). At least one file type MIDST be selected. Fax to 209 464-0138 or M211 to the <br /> address Indicated above. <br /> 2. EHD will natlfy the applicant I-Iany EHG files exist An appointment for review will be confirmed <br /> approxirnately five business days but no later than ban (10)days jifter receipt of application. The file: <br /> will be held for a maxirnurn of five business days for review. Appointments should be Scheduled � <br /> accordingly. <br /> 3. A file that is actively being worked an by EHI}staff may not be immediately available forreview- A n, <br /> appEcation may be submitted when tho file is available. <br /> 4. Any fila not rstarned in the same condition as released will be reorganized by EHD staff at the a xpen! <br /> of the applicant. F=uture file reviews by the same applicant may require a$93.00 deposit prior to re it <br /> 5, *TENTATIVE appoinlsnesnt dates must be con finned with WD staff. <br /> 6. Applications received after 3:00 prn will be processed the next business day. <br /> CONFIRM5b AppalmWENT DATE TIME <br /> BATE CONFIRMED -PHONE . FAX �NlTIA1rS""__.- <br />` REVIEWED YES NO RMEW DATE <br /> TOTAL P:O: _ <br />