Laserfiche WebLink
R <br /> rrLa7E9D 34 84� 2094671118AGE STOCKTON PAGE .01/6 <br /> �r � SAN .JQUIN COUNTYPUBLIC HEALTH S VICES erio uac NUM ![:R k <br /> ENVIRONMENTAL HEALTH DIVISIOR' <br /> ,IAN ► 7 2005 304 EAST WEBER AVENUE,THIRD FLOOR <br /> i STOCKTON CA 95,202 <br /> lye H'EAt�N '` <br /> too <br /> E!i'�I�ORmENACES PUBLIC RECORDS 9 SL�44SE APPLICATIONAPPLICANT <br /> s <br /> BUSWESSJAGENCV �l <br /> ADDRESS 42 , • ': A i <br /> PHONE-'t[&'7 16 0(p 467 1 IR <br /> TENTATIVE"APPOINTMENT DATE :TIME <br /> (Please give 7 to 10 business days from date of application submitw) <br /> L I <br /> CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE—REQUEST PROCESSE17.1N 3 BUSINESS DAYS <br /> l <br /> SIGNATURE OF APPLICANT kX DATE -7 IS <br /> �i <br /> FILE ADDRE55 <br /> F <br /> 5 <br /> _3_52L <br /> x <br /> ENVIRONMENTAL HEALTH piVISION FILES <br /> NDERGROUNb YANK{UST)CLEANUP SITE(LOP) ❑ HOUSING ADATEM <br /> UE)YT © SOLID WASTE FACILITY <br /> Y❑ OTHER CLEANUP SITE(NON-LOP) 17 FOOD FACILITY C1SOLI1)WASTE VEHICLE <br /> O UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL. ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 1 ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILrrY ❑ MOTELIHOTEL ❑ PUMPER TRt1CKrYARD/CHEM TOILETS <br /> ❑ TATTOOlBODY PEiRCING Ll POOLISPA ❑ LAND USE APPLICATION$)TES <br /> ❑ MEDICAL WAStE FACILITY ❑ PUBLiC WATER SYSi`fEM CI OTHER(PLEASE SPECIFY ABOVE) <br /> 7. List up to ten addresses in the Space above. Select theitype(s)of files from the list above by checking I <br /> the appropriate box(es). At least one rile type MUST b6%elected. Fax to (2091464-0138 or mail tot e <br /> address Indicated above_ <br /> 2. EHD will notify the applicant if any EHD files exist. An`�ppaintrtment for review will be confirmed <br /> approximately five business days but no later than ten 1(4, 0) 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 irnmediately available for review. A new <br /> appliCation.may be submitted when the file is available. <br /> d. Any file not returned in the same condition as releasedwill be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the Same applicant may require a $78.00 deposit prior to review, <br /> 5. `TENTATIVE ,appointment dates must be confirmed with EHO staff, <br /> 6. Applications received after 3:00 pro will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATs 71M1= <br /> DATE CONFIRMED <br /> PHONE FAX <br /> INITIALS <br /> REVIEWED YES NO REVIEW DA'T'E <br /> EH 60 74 01105700 <br />