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U002 <br /> Cr1V LVV J\VIVIV V <br /> i0J28/2004 13:24 FAX 209 9481 <br /> DATr°REGI=1vED SAN JOAQM COUNTY <br /> ERON [EN�'A-L HEALTH IDEPARTNIENF <br /> N <br /> 304 L Weber A.ve P Floor Stockton, CA 95205 <br /> (209) 46S-3420 Fax: (209)464-0138 Web:www.c0.san-j0aquin•ca.us/ehd <br /> PLTBLIC pXCO"S RELEASE AypLICNTION <br /> ApPjjCANT- I { s5i,h BUSINESS(AGENCY: <br /> ADDRESS', <br /> PHONE: <br /> �n! FACSIMILE; oltd� <br /> TENTATNE'APPOINTMENT DATE. <br /> IV(1. Tune: <br /> (Abase allow 10 business days from data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-593.00 FEE-REQUFST PROCESSED IN 313USINF-SS DAYS I a� <br /> •�] �=J _ DATE <br /> SIGNATURE OF APPLICANT DeoertmentUse OnlY <br /> UNIT <br /> FILE ADDRESS <br /> ❑ <br /> Unit 1 <br /> z. s 3\►t Nt�x �'" a °`;) . A Unit 2, <br /> �nwcityk v4 i1�. Unita <br /> - <br /> 6. sum taoo G ',J�' Unit 4 <br /> s1.�I t K ct`trn <br /> �4 ' ❑ Unit 5 <br /> ' G <br /> -ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NG pgAEMEN7 [IpQ SOLID WASTE FACILITY <br /> J& UND ❑ HOUSING ERGROUND TANK(UST)CLEANUP SITE(LOP) d FOOD NG ABTILITY SOLID WASTE VEHICLE <br /> S OTHER CLEANUP SETT:(NON-LOP) ❑ F00 KENNEL IM DAIRY <br /> UhIb�ZGROUND TANK(MONITOR1NGMEMOYAL) O CHICKEN RANCH 4 PKG TREATMENT PLANT <br /> EA <br /> 1S HAZARDOUS WASTE GENERATOR ❑ MOTELFHOTEL TZ PUMPERTRUCKIYAMCHEM TOILETS <br /> Q TjERFD pEPMrrTED FACILITY E3POoLrSPA LAND USI APPLICATION 5rfES <br /> ❑ TATTOOlBODY PIERCING ❑ OT1iER(PLEASE SPECIM <br /> D MEDICAL WASTE FACILITY checking <br /> to ten addresses in the space above. Select the types) of files from the list aboye by <br /> 1. List up type MUST be selected. Fax to 209 464-0138 or mail to the <br /> the appropriate box(es). At least one file <br /> address indicated abo le. y ointment for review will be confirmed <br /> 2 EHD will notify the applicant if an EHD files exist An apPof r_ation. <br /> approximately five business days but nafte <br /> da s forr than ereviowa AppointMe ays r e�shoo dpbe scheduleedf les <br /> will be held for a maximum of five business Y <br /> accordingly. not be immediately available for review. A neK <br /> 3, A file that is actively being worked on by EHD staff may <br /> application may be submitted when the file is available. <br /> applicant may require a$93.00 deposit prior to review <br /> q, Any file not returned in the same condition sareleased <br /> e aPP d will be reorganized by END staff at the expens <br /> of the applicant. Future filo reviews by <br /> 5. *TENTATN.appointment dates must be confirmed with EHD sb <br /> 6 Applications received after 3:00 pm will be processed the next businoss day. <br /> TIME <br /> ;Ct�NFI,RMFD APPb[NTMENT DATE` ;.r ':a Y; <br /> PHONE FAX <br /> :DATE-CONFIRMED <br /> ,. . YES NO REVIEW DATE: <br /> REVIEWED <br /> • E}{Q�S-0ZA4G <br /> yy/j001 <br />