Laserfiche WebLink
® A IF <br /> U t OG NUMBE-P <br /> REQ SANJoAgvz�c Covrr'xYMr- Q <br /> Errvz.RONmEN-rAL xxALTH UUPARTMENT <br /> (BAR 13 2005 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> (209) 468-3420 T?ax:: (209) 464-0138 Web: www.co.sart joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH <br /> I'ERMIT/SERVICES PUBLIC P ECOFDS_PtELEASE APPLICATION <br /> APPLICANT: TC � BUSINESSIAGENCY: <br /> PHONE: FACSIMILE 9M �!(! g ' %2Z—f �,q <br /> TENTATIVE"APPOINTMENT DATE:�„ t � rime:,w /'-1` f" _ <br /> (please allow 10 business days from date of application submittal) <br /> ® CHECK BOX TO EXPEDITE REQUEST- 93.Q0 FEE/—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT °�- i ��� DATE � <br /> Department Use Only <br /> FiLE ADDRESS UNIT <br /> 9. street � V a' 8C6 ❑ jUnjt2 <br /> Al 1 2. Street } ci <br /> ."ta cll ❑ Unit <br /> 4. Street W !�+ t r'i V✓1 4 city '� <br /> I cl 5. Slrv�E. street —�. street e, street <br /> Cil ❑ <br /> 9, Street <br /> " Ct <br /> 90, streer <br /> ENViRONMENTAL HEALTH DEPARTMENT FILES <br /> Lir UNDERGROUND TANK(USC)CLEANUP SITE(LOF) ® HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> W OTHER CLEANUP SiTE(NON-LOP) ❑ FOOD FACILITY C3 SOLiD WASTE VEHICLE <br /> U///UNDERGROUND TANK(MONITORING/REMOVAL) E3 DOG KENNEL 0 DAiRY <br /> Q A�ARDOUS WASTE GENERATOR O CHICKEN RANCH © PKC TREATMENT PLANT <br /> Ca TiER1=D PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCIC1YARD/CHEM TOiLETS <br /> ❑ TATTOOIBODY PIERCING ® POOL15PA M LAND USE APPLICATION SiTES <br /> ❑ MEDICAL WASTE FACILITY d OTHER(PLEASE SPECIFY) <br /> 1, List up to ten addresses in the space above. Select the type(s) of files from the list'aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464._0138 or mail to the <br /> address'ndicated above, <br /> 2, D fifes exist. An appointment for review will be confirmed <br /> EHU will notify the applicant if any EH <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 /> 4. Any file not returned in the same condition as released will be reorganized by EMD 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 /> CONFiRMED APPOINTMENT DATE TIMi" _ �. <br /> DATE CONFIRMED PHONE FAX INITIALS �— <br /> REVIEWED YES NO REVIEW DATE <br /> EMP na•o2 00rt <br /> 0/8/2003 <br />