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r <br /> /19/2005 12:56 FAX 209 948062 .10002/002 <br /> . �'i•11..1 w•a ivrw.t� <br /> ID (n� SAN JOAQUIN COUNTY Asm moos <br /> • M-1 IMP Iu' V - ,ff <br /> ENYYRon1ENTAT..MA,LTH DEPARTMENT <br /> SEP 1 9 2005 304 E Weberme P Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:wwtiw_co.san,joaquin.ca.us/dhd <br /> ENVIRONMENT HEALTH <br /> P•ERNMIT/SERVICES p TB,LjC R.]gCopDS PELF+A.SE AYPLYCATION <br /> APFUCANT: _ b _` ®USINESSlAGENCY: <br /> AndRESS:7� Z. S'VS a5CA- <br /> -C`y <br /> PHONE �Aq^ Q! ' 1 FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: L D <br /> {Please silcm 10 busirsess days from date of 3PI3rKatl0n submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-saam me—RElaUEST PROCESSED IN]®USIHESS DAYS <br /> SIGNATURE OF APPLICANT DATE SZ <br /> Department Use ONY <br /> UNIT <br /> FILE ADDRESSPgg <br /> Just (Z7 1 Q �_ _ ❑ Unit 1 <br /> ss �- 20D <br /> 0. c Unit 2 <br /> '�►ihS'1' �•1�•'� a su=ms ,r• 1 <br /> • s unit 3 -11 <br /> (� 7, summa ZZ 1,J• 4W4 .Nil U <br /> 9 fihee! <br /> it 5 <br /> 1d. Shed as t <br /> _ �� TE FACtLc Y <br /> U140ERGROUND UNK �' TE YENIGLE <br /> OTHER G1.E.&NUP SITE _ <br /> m UHoERGROUN4 TANKfMENT PLANT <br /> � � _ <br /> ADKpzARDQuS WASTE G � 1JGKlYARDICt-�HEM TQ4AM <br /> ❑TIERED PEEtMf►TED FA ' <br /> �� "�` �' APPL.ICATION SITES <br /> TATTOOBOOY PIERGIN <br /> ❑ ME131CALWASTE FACi <br /> , .a dyx %'she fist above 6y GheC <br /> '. Ust up to to K '. z <br /> 464-0138 or mail to <br /> pproP <br /> _ thea r1 ��� � <br /> address'ind •- mill be confirmed <br /> 2• EHD will no of application. The files <br /> approximat <br /> �. ,should be scheduled <br /> will be held r g "Amp <br /> according) � i f'a r a��°� r k a `` s`� Vailable fOC review• w <br /> c a <br /> A file that i <br /> ,P <br /> applications <br /> EH staff at the exp <br /> 4. Any file no x Y <br /> "� � ,,. $,� �` � -�. ,� �3A0 deposit prior to review. <br /> of the 2PPR <br /> s. `TENTATi�i <br /> Y <br /> g• Applicatiord <br /> 4. <br /> �Jr�l�{}. �•�?,'t•�f ta"" _§` -{ ,'ts -'',., t- 'tet `ciwe".xv - ? .�'� <br /> "QA`t'ECrQNFIE_�ED .. ."'�':' t'PHONE • FAX'" �;�.. t�NF•�IALS '���— <br /> V .\•• _ <br /> REVI WED �1 ES NO REVIEW DATE <br />