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F-HD LOG NUMBER <br /> DATF_RECFIVEDSA1v JOAQU11*l �.OTJJ.NTY <br /> ErmRONMENNAL HEALTH DEPARTMENT <br /> 304 E W ber Ave 3rd.plQor Stockton, CA 95205ov <br /> (209)4.68-3420 Fax: (209)464-0138 Weil: www_co.san�joaquin.ca.��slektd <br /> PUBLIC MCO"S RELEASE A.PPL1q9j=r4 <br /> APPLICANT: ` 3. BUSIHES$lAG1=HGY: S/ �" - <br /> �I DEP<<R1ACT <br /> ADDRESS: I� � <br /> Pt�oNi;. FACSIMILE: <br /> ;i <br /> 3 <br /> TENTATIVE"APPOINTMENT DA'Tt;: G{. U 'I"tme: Olt <br /> 4 <br /> (Please allow 10 business days from date of application sUbt,ittal) <br /> Cil <br /> HECK BOX TO EXPEDITE REVST3.0 I E—REQUEST PROCESSE:b IN 3 BUSINESS DAYS11 <br /> }} <br /> SIGNATURE OF APPLICANT DATE U c ! <br /> Department Use Only <br /> tl <br /> FILE ADDRESS' UNIT <br /> 1 sheet I?. ! NK o ❑ Unit 1 <br /> sIrrei t l Hy at, C;tzwU4,t+s `�g '� �- ❑ 'Unit 2 <br /> 4. Stree, ;Zoy2q I !�,L. t2'I C 2- Hy . O <br /> s, s,sc te <br /> Unit 3 <br /> cu 0mom <br /> •`te r' <br /> i.__sy_eet _ o?t?�I R F. U. E'2�'F a vs.r+,n� Unit� 1 <br /> 96, afe4,. Gity ❑ Unit 5 <br /> r0 s,rn¢i <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I3�rUNt7ERGROUND TANK(LIST)CLEANUP SITE(LION ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> 01—AER CLEANUP SITE(NDN-Lop) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> t //UHI3EftGROUND TANK(MONItdFtING(REMOVAL) ❑ DOG KENNEL. Q DAIRY <br /> 6 AZA�RDDUS WASTE GENERATOR C7 CHICKEN RANCH LI PKG TREATMENT PLANT <br /> t T]ERED Pl_RAII`rTE17 FACILITY ❑ MOTEIIHOTEL ❑ PUMPER TRUCK(YARDIGHEM TOILETS <br /> ❑ TATTOOISODY PIERCING 0 POOLISPA ' 13 LAND USE APPLICATION SITES <br /> 11 MEDICAL WASTE FACILITY Q OTHER(PLEASE SPECIFY) <br /> �. List up to ten addresses in the space above. Select the type(s) of fifes from the list'above, by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)454-0138 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 110.later than tett (10) days after receipt of application. The,ffles <br /> wilf beheld for a maximum of five businss days for review. Appointments should he scheduled <br /> accordingly. } <br /> 3. i1 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 sauna 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 3:06. pm will be processed the next business.day. <br /> it <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED __ PHONE FAX INITIALS <br /> REVIIE,WED YES NO REVIEW DATE <br /> i�/87200� ' <br /> II . <br />