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iceP'28/2004 13:24 FAX 209 9480X1003 <br />DAT'. REPENED SAN JOAQUIN COUNTY <br />E -V1R0NMNTALHEALTHDEPAPTMZNT <br />N loon <br />304 *E Weber Me Td Floor Stockton, CA 95205 <br />(709) 469-3420 Fax: (209) 464-0138 Web: vwW-cO.&2n­jOaq_Ui1Lcaus/ehd. <br />pUBLIC pXCORDS RFLFASF, APPLICATION <br />APPLICA?M. BUSINESSIAMOY. <br />ADDRESS: <br />;3r7qj <br />PHONE; T <br />TENTATIVE* APPOINTMENT DATE: Tim: <br />(please anow 10 business days from date of application submiltal) <br />■CHF REqUF SS <br />CK BOX To EXPEDITE REQUEST - $93.00 FEE e—; _ST PROCMED *13 BUSINE DAYS <br />SIGNATURE OF APPLJGANT I DATE <br />DeparbMA Use Ody <br />■ <br />Unit I <br />Unit 2 <br />Unft 3 <br />Unit 4 <br />[3 unit 5 <br />ot UNDERGROUND 40 SOLID WASTE FACILITY <br />.ROUND TANK W" CLEANjjp SM (LOP) 0 HOUSING ABATEMENT <br />18 0 SOLID WASTE VEHICLE <br />OTHER CLEANUP SITE (NON -LOP) 13 FOOD FACILITY <br />Ig UNDERGROUND TANK (MONn­OFj"GMM0VAL) 0 DOG KENNEL a DAIRY PLANT (> <br />E3 CHICKEN RANCH 1111. PIKG TREATMENT <br />in HAzARDOUSWASM GENERATOR C3 MOTELIHOTEL 0 PUMPER TRUCKrYARDMHEM TOILETS <br />13 TIERED PERMITTED FACILITY [3 POOLISPA UL LMD USE APPLICATION SITES <br />13 TATTOGIBODY PIERCING 13 OTHER (PLEASE SPECIFY) <br />0 MEDICAL WASTE FACRZY <br />1. List up to ton addresses In the spare above. Select the type(S) Of files from the list above oy checking <br />the appropriate box(es). At least one file type MUST be selected. Faz to 209 464-0138 or mail to the <br />adores$ indicated above_ <br />2. 'EHD will notify the applicint 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.v review_ Anew <br />3. A file that is actively being worked on by EHD staff may not be immediately available for re I <br />application may be submitted when the rile is available. D staff at the expense <br />as released Will be reorganized by EK <br />4. Any file not returned in the same condition uire a $93.00 deposit Prior to review <br />of the applicant. Future file reviews by the same applicant may req <br />*TENTATIVE appointment dates must be confirmed With EHD staff. <br />6. Applicatio' received after 3:00 pm Will be processed the next business day. <br />Applications <br />b <br />"�MF_TIME <br />Ni' - AT. <br />T - A ON F- .1 R M'E'D .��.PNQIdE FAX: <br />R EW <br />REME.WjED -YES iM DATF-- <br />LW200y, <br />