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01/14/2005 09:46 FAX 209 948062. ID <br />RECEIVED <br />40 - <br />ENMONMENTALREALTHa.7A'tJCE'SitAMA:9N <br />344 E Weber Ave 31' Floor Stockton; CA 95205 <br />ORRR 468-3420 Fax: (209) 464-0138 Web: vrN,.y.co.sm-joaqWa.=us/ehd <br />, <br />DD , <br />PHONE: FACSI 'MILE. s <br />121002/002 <br />TENTATM* APP61NTMENT DATE: / cI _IZ-00 <br />Time: <br />{Please allow 10 business days f -wn date of appfcatlan suhmlttsl) <br />CHECK BOX TO EXPED'TE REQUEST- $93,00 FLEE, REQUEST PROCESSED IN 3 BU$INESS DAYS � <br />SIGNATURE OF APPLICANT DATE 1 <br />1440-E�- <br />Departrnenc use only 0 <br />0 O t 1 <br />111 <br />-ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNIT' <br />I . <br />D Unit 1 <br />Unit2 <br />l\ � <br />D- Unit 3 <br />Unit 4 <br />p Unit 5ul <br />Prul`�^v <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ISI.. SOLID WASTE FACiL.nY <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY d 5000 WASTE VEHICLE <br />i� UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNa & DAIRY <br />ffi• HAZARDOUS WASTE GENERATOR El ClilCXV-N RANCH 19-PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTELlHOTEL ❑ PUMPER TRUCIVYARDICH5M TOILETS <br />❑ TATT001800Y PIERCING ❑ POOLISPA M LAND USE APPLICATION Sr S$ <br />❑ MEDICAL WASTE FACILITY d OTHER (PLEASE SPECI <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list aboye py 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, EHO 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 />a. 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. <br />'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 />uY 4N(ry�t9.Pt'�.;y', MFF • ~ 1NTN,!• `� rk'' �:+'.:. y -c •, _, , c:`'1�a-_. <br />.•� •"� !.!L^.®�� ENT•DAT �•:i 1 .—' ri.. .Y�)ti�:.• w''i� •1 \.�' •'•.. <br />Y. <br />.�� h, � '•t'nc.;tl h �.'• /" ')• 1IM� •.5i1 •.. Y.te. a�P: u'.. .h.a .' :J�P.'',�' <br />DATE•CQNFIRMECi <br />FAX <br />®E �� tiNiL1ALS'.: <br />REVIEW.ED YES NO REVIEW DATEL, <br />PEI •tn-a2-Mr. <br />