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12/28/2003 18:38 925283 ''1 <br />AEI CONSULTANTS) PAGE 01 <br />EHO LOG NUMBER <br />DATE RECEIVED SAN JOAQi7IN COUNTY <br />11 7 <br />ENVIRONmmNTAL HEALTH DEPARTMENT <br />304 E Weber Ave 3d Floor Stockton, CA 95205 <br />DEC 3't 00468-3420 Fax: (209) 464•-0138 Webs www.co.san joaquuLca us/ehd <br />C) � WE: N T I E Ai_' PUBLIC PXC01WS RELEASE,42PLICATION <br />APPLICANT:1 - i-- BUSINLSSIAGE(N�CY. <br />ADDRESS: 1nD SID .0-` t, , <br />PHONE•071 ti(.CJ �ilaL4t✓ FACSIMILE: �— <br />TENTATIV>PO* AP 1NTmENT DATE' c�la 12� Time, <br />Please allow 10 business days from date of application submittal) <br />® CHECK BOX TO EXPEDITE REQUEST493,00 393.00 F £ -REQUEST PROCESSED IN 3 BUSINESS DAYS ) <br />SIGNATURE OF APPLICANT dU n----'- DATE I �o � ,� <br />Department Use OnlY <br />i <br />UNIT <br />v <br />V� <br />a <br />C3 Unit 1 <br />Unit 3 <br />Unit 4 <br />a { ►. ♦ , Unit 5` <br />y <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />U HOUSING ABATEMENT <br />3SOLID WASTE FACILITY <br />❑ SOLID WASTE VIEHICLE <br />M OTHER CLEANUP SITE (NON -LOP) <br />DK UNDERGROUND TANK (MONITORINGIREMOHAL) <br />C1 FOOD FACILITY <br />[3 DOG KENNEL <br />❑ DAIRY <br />> k HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />KG TREATM ENT PLANT <br />❑ PTRUC LARD CHEM TOILETS <br />$1 TIERED PERMITTED FACILITY <br />d MOTEUHOTEL <br />D POOUSPA <br />LAND USE APPLICATION SITES <br />TATTOOIBODY PIERCING <br />❑ MEDICAL. WASTE FACILITY <br />0 OTHER (PLEASE SPECII� <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checkinc <br />the appropriate box(es). At least one file type MUST be selected. Fac to (209) 464-0138 or mail to the <br />address indicated above. <br />2. END will notify the applicant if any I:HD 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 ne• <br />application may be submitted when the file is available. <br />4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expens <br />of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to revie' <br />6. "TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED. APP®INTMENT .DATE <br />XlME <br />DATEGO1Vl=1l2MEQ • ' PitONE • fAX . <br />REVIEWED �� .:.. `Y)=S NO <br />REVIEW DATE <br />