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01/14/2005 09:46 FAX 209 9480623 <br /> r, 0002/002 <br /> RECEIVED COUNTY <br /> -s <br /> \ SAN J OAQ C® 'y cnu`%01.21 <br /> FNm0NMNTALRE.ALTRDEPAPTbMNT mama. Ob, <br /> 304 E Weber Ave 3`d Floor Stockton;CA 95205 <br /> . AN 1 OPRP 468-34207Fax: (209)464-0138 Web:8v-ww.co.sm-joaquiucaus/chd <br /> ENVIRONMENT HEALTH PU13LIC CO S. ALV EPRIlYi-Deft WSLASEPLZCA.'T'ION <br /> APFLI ate.. S;.f� <br /> . BvslivlsssIAGa=xcr. e;,ti <br /> ADDRESS: o�2'5 V. thtyf-tl�, '% -ea_ .. ���. <br /> C-1-4 q ®S <br /> PHONE: - v FACSIMILE: <br /> TENTAT *APPOINTMENT DATE: <br /> Tone: IR.00 <br /> (Plea_ae allow 10 business days from ttato of application subrnitbd) <br /> t j <br /> CHECK BOX TO EXPEDITE REQUEST-;93,0®FEE,REQUEST PROCESSED 1N 3 SU$INES5 DAYS <br /> SIGNATURE OF APPLICANT DATE 10 <br /> \, D.-I"ent Use Only <br /> " FILE ADDRESS UNIT f <br /> 1��u5 z sued t r ® Unit 1 <br /> to <br /> 4. mredo <br /> Ga Unit 2 <br /> w 5 6. am ►� 1 fto e ee Unit 3 <br /> i,r j t" y. Street ►e <br /> e. suKe Unit 4 <br /> 2. Skad FEB ' <br /> r " p Unit S <br /> • 10. Swed � <br /> -ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> TANK NST) <br /> UNQERGRQUND CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 5L souD WASTE FACILrry <br /> OTHER CLEANUP SrM(NON-_0p) d (FOOD FACILITY ❑ 5000 WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING(REMOVAL) ❑ DOG KENNEL, M-DAIRY <br /> JSHAZAROdUs WASTE GENERATOR ❑ CHICKEN RANCH PKG TREATMENT PLANT <br /> ❑ TATTED PERMITTED RAGILrfY 13MOTEUMOTEL ❑ PUMPER TRUCKfYARDICHEM TOILETS <br /> 13 TATTOOlBOQY PIERCING ❑ POOLISPA M LAND USE APPLICAnoN snes <br /> ❑ MEDICAL WASTE FACILITY EL OTHER(PLEASE SPECI <br /> t. List up to ten addresses in the space above. Select the type(s) of fiiesfrco,m�thest above by checkingthe appropriate box(es). At least one file type MUST be selected. F -•0188 or mail to the s <br /> address. r <br /> indicated above. <br /> 2• EHCI will notify thi applicant if any EHD tiles 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 /> s• Applications received after 3.00 pm will.be processed the next business day, <br /> D aI?PCaINT aiAT :' �''.�' _. :.. <br /> r:•�/�-r. /r�; "c':,t.•wg;•'._c.':�' •�lM� •.'.k�t.�.-" •:a:aw.•:A., ,' ':.✓•P.i';:i' <br /> i�DATE•C.QNFIR <br /> QED "' ^ PHONE . <br /> ,. •.• •. •: FAx ��•,�:;.'r+fN11TUu:S ' •..,•,. ;?�'• { <br /> .REVIEWED YES No REVIEW DATE' ' r <br /> ENo;a aT 4a6 <br /> { <br /> t <br />