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DEC. 8. 2003 2: 16PM CONDOR- EARTH TECH NO, 1.697 EHcP, 1NUMBER <br /> DATE RECEIVED 0 SAKI JOA,QM COUNTY <br /> �'n Ert71 vmo AL MAL'H Dva <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> [)C 468-3420 Fax: (20 9)464-0138 Web:www.ca.sau joagnin.ca.us/ehd <br /> .pUB IC RFCORJ)S RUEASE APPLICATION <br /> iiVll J - II <br /> APPLICANT: ?r� }�,�(r�L- SUSINESSIAGENCY: <br /> ADDRESS: �O <br /> � G KTo <br /> PHONFi l of �2_�FACSIMILE: 2 - <br /> TENTATIVE- <br /> -TENTATIVE''APPOINTMENT DATE: C�C� � � Time: <br /> (Plmse allow IQ business days from date of application submittal) <br /> CHECK 13OX TO EXPEDITE REQUE 3.00 FEE—REQUEST PROCESSED iN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APf'LBCANT � c-o3 <br /> Department Use On1Y <br /> UNiT <br /> FiLE ADDRESS <br /> St ❑ Unit 1 <br /> v <br /> z steal 2 <br /> A 4. Sty <br /> s. s <br /> 114 <br /> O 3 <br /> k 8. street O �. <br /> �, �, PO4.1i <br /> .K 7- Wart ,� <br /> ;c 9. s� o a DEL. 1 8 p Uni <br /> X 9. street <br /> 10. 9Veat � P.C.�.- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOUDSOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) Ci FOOD FACILITY DAIRY WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIFtEMOVAL) O DOC KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH PKG T REATMENT Pt ANT <br /> 14 TiEm PERMITTED FACILITY ❑ MOTELJHOTEL C] PUMPERTRUCKIC on M TOILETS <br /> ❑ TA1700BODY PIERCING 0 POOMPA CI LAND USE APPLICATION S <br /> ® MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list aboye y checking <br /> the appropriate box(es). At least one file type MUST be selected_ Fax to 209 464-0138 o 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 co firmed <br /> approximately five business days but no tater than ten(10) days after receipt of applica on. The tiles <br /> will be held for a maximum of five business days for review. Appointments should be heduled <br /> s <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. d 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 /> S. '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 /> CONFIRMF-D APPOINTMENT DATE TiM4 <br /> DATE CONFIRMED 'PHONE • FAX 1NiTIALS - - <br /> REVIEWED YES NO REVIEW DATE' . <br /> ap�a.azaoc <br />