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06/16/04" WED 08:49 FAX 9167013 KLEINFELDER <br />DATE RECEIVED 10 SAN JOAQUIN COUNTY <br />FD <br />�4200P09) <br />E (� ENVIRONMENTAL HEALTH DEPARTMENT <br />U L U 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br />JUN 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.caustchd <br />t t11151 F Zvi 2 e W <br />BUSINESSIAGENCY: lam' P 1 n T Q l d EC O . <br />10 <br />ADDRESS: <br />3077 <br />iek. ' <br />0 SOLID WASTE FACKM <br />• <br />0 FOOD FACfLITY <br />,FACSIMftX--.• <br />I 13 <br />TENTATIW APPOINTMENT DATE: up r earl IPST Ellf <br />CCIDITTe: <br />Tease allow 10 business days from date of application submittal) <br />❑ CHECK BOX TO EXPEDITE REQUEST- $93.00 FE REQUEST PROCESSED IN 3 BUSINESS DAYS ! <br />SIGNATURE OF APPLICANT DATE�04 <br />Gide e <br />❑ Unit 1 <br />Unit 2 <br />Unit 3 a� <br />Unli 4 <br />❑ Unit 5 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />Lm UNDERGROUND TANK (t1ST) CLEANUP SITE (LOP) <br />LB HOUSING ABATEMENT <br />0 SOLID WASTE FACKM <br />0 OTHER CLEANUP SITE (NON -LOP) <br />0 FOOD FACfLITY <br />0 SOLID WASTE VEHICLE <br />E5 UNDERGROUND TANK (MONITORINGIREMOVAL) <br />0 DOG KENNEL <br />0 DAIRY <br />$21 HAZARDOUS WASTE GENERATOR <br />O CHICKEN RANCH <br />0 PKG TREATMENT PLANT <br />O TIERED PERMITTED FACILITY <br />0 MOTEUHOTEL <br />0 PUMPER TRUCWYARD04EM TOILETS <br />0 TATTO01BODY PIERCING <br />0 POOLISPA <br />0 LAND USE APPLICATION SITES <br />0 MEDICAL. WASTE FACILITY <br />0 OTHER (PLEASE SPECIFY) <br />1. List up to ten addresses In the space above. Select the type(s) of files from the list aboye 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 returned 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. <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED ; PHONE <br />TIME <br />FAX : INff1ALS ' <br />REVIEWED YES NO MMEW DATE <br />