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rSAN JOAQUIN COUNTY <br />MENTAL HEALTH DEPART%MNT <br />p% � j SO4 hast -Weber Avenue, r Floor, Stockton, CA 95202-2708 <br />%h <br />0 10 qrl-lephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org1ehd <br />WMT <br />;L 11 i I %, I g 04 <br />tNU LUU NUMtJt:K <br />PHONE (1): PHONE (2): 14r a � FACSIMILE: -7"+;k—S__C( <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business %4s from date of application submittal - *Tenta6ve only - must be confirmed) <br />SIGNATURE OF APPLICANT <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FAcILITYIVEHICLE <br />OTHER CLEANUP SITE (NON -LOP) 13 FOOD FACILITY 13 WASTE TIRE <br />NDERGRouND TANK (MONITORING/REMOVAL) El DOG. KENNEL 0 DAIRY <br />RDOUS WASTE GENERATOR 13 CHICKEN RANCH 13 WASTEWATE EATMENT PLANT <br />T T TIERED PERMITTED FAciLrry 0 MOTELIHOTEL E-3 PUMPER UC HEM TO <br />A 'TT' <br />TToolBooY PIERCING 0 POOLJSPA E3 LAND Us APP CA N SITE <br />13 MEDICAL WASTE FACILITY E3 OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY -FRIDAY 8:00 Am-6:00pm (DAYS. <br />1. List up to ton addresses in the space above, Select the type(s) of files froleth'e list above by checking the <br />appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address <br />indicated above. Address ranges will not be accepted —for additional assistance with file addresses, contact <br />the EHD. Applications received after 3:00 pm will be processed the next business day. <br />2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed IV <br />approximately ten (10) days after receipt of application. The files will be held for a maximum of five business <br />days for review. Appointments should be scheduled 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 whent a file is available. <br />4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the <br />applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />EHD 48-02-006 <br />11123104 <br />