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TE,RECEIVED F-1113LOGNUMDER <br /> SAN JOA.QUIN COUNTY <br /> 1ENVIRON NTAI.,E[)EAX,.TH DFPARTMNT 6 1 <br /> `� iJ 304 E Weber Ave 3`d MOOT StOCkton, CA 95205 <br /> _( NA68-3420 Fax: (209)46401.38 Web: www_co.san joaquin.ca.us/ehd <br /> s <br /> U3 .ICRECORDS EAS ' ' <br /> APP� CAxOT <br /> APPL.,C � S�,n,l 7sy� BUSINESS/AGENCY: cs._ E rtcGf� � t <br /> ADDRESS' 62- i-ool 1 22)_ — <br /> PHONE: c J[[/�_3�0 FACSIMILE: J - q22 <br /> TENTATIVE"APPOINTMENT DATE: Oe.-t 0 S Time. <br /> (Please allow 10 business days from date of application submittal) <br /> Q CHECK BOX TO EXPi:DiTE REQUES -$93,00 E REQUEST PROCESSED IN 313USINESS DAYS <br /> SIGNATURE OF APPLICANT ' -` DATE <br /> Department Use Only <br /> Q PILE ADaRESS +/� UNIT' <br /> 5Azcy�' P o ❑ unit I iv <br /> NIN ti W ID` a. seed « <br /> VV '1 <br /> 4. Street <br /> O <br /> s, street Unit 3 <br /> nEff— I b.— 00 <br /> tS. Street <br /> 7. 9itN�t <br /> en - 1. 7i —.._ Uf1it <br /> 9, Street � ' <br /> aw <br /> ta. S�f4'sl ❑ Unit 5 <br /> R0, StrtMt G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FiLES <br /> I/UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> L OTHER CLEANUP an-e(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ® DAIRY <br /> STE GENERATOR ❑ CHICKEN RANCH d PKG TREATMENT PLANT <br /> REb PERMITTED FACILITY Ll MOTELIHOTEi, 1� PUMPER TRUCKtYARi?/CH1=M TOILET <br /> ❑ TAr1'OOBODY PIERCING D POOLISPA ❑ LAND USE APPLICATION SITES <br /> ClMEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of filet from the list'above.i'y checking <br /> the appropriate box(es). At feast one file type MUST be selected. Fax to 209 464-0138 or nail 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 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 availabies 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 same 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 3:00 pm will be processed the next business.day. <br /> CONFIRMF-D APPOiNSMENT DATE; TIME <br /> DATE; CONFIRMED _ PHONE FAX.' INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> K: 0 ae-02.006 <br /> tt�anooa ' <br />