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FROM : Geo-Phase Environmar — Inc. FAX NO. : 2095690295 Jan. 13 2004 10:24AN P2 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> V ENTAL HEALTH DEPARTMENT <br /> U5 ENVIRONIM <br /> rc_((, <br /> �8�v <br /> 304 E Weber Ave P Floor Stockton, CA 95205 <br /> j Aj 33 ',_T(M9) 468-3420 Fax: (209)464-0138 Web: www.co,san-joaquin.ca.us/ehd <br /> I <br /> HFEA�_ H PuB <br /> � LIC RECORDS "LEASE APPLICATION <br /> APP L ICANT 57,111, BUSINESS/AGENCY- �reiP'144PX6- <br /> ADDRESS:.Z-j?_3 7 <br /> PHONE: —FACSIMILE: 1�p <br /> TENTATIVE*APPOINTMENT DATE: f___r Iva Time: <br /> (Please allow 10 business(lays from date of application submittal) <br /> 0--CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST'PROCESSED IN 3 BUSINESS DAYS <br /> 4 <br /> SIGNATURE OF APPLICANT DATE <br /> 1e_Z/11_ <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> CIty E] Unit 1 <br /> /11� I,/ al A- Oy mot <br /> 3. Street' — CIty ❑ Unit 2 <br /> 4 streot cAly <br /> 5. -.street oty ❑ nit <br /> , 3 <br /> 6. Street a ry <br /> 7. Street My — Unit 4 <br /> B. street atv <br /> 9, street aty Unit 5 <br /> 10, Stmct 0�y <br /> 1_It <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> El UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WAS AGILITY <br /> >�'OTHFR CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> 11 UNDERGROUND TANK(MON ITORIN GIREM OVAL) 13 DOG KENNEL 13 DAIRY <br /> 171 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH El PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEUHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> C) TATT001BODY PIERCING U POOUSPA 0 LAND USE APPLICATION 5FrFS <br /> 0 MEDICAL WASTE FACILITY 0 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. EHD 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 retumed 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. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. Rpm IN ff Awn a <br /> -7 <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED w YES NO REVIEW DATE <br /> EHD 48-02-006 <br />