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v FROM :Sau San FAX NO. :510-436-4780 08 2003 08:23AM P1 <br /> 09/05/2003 11:Q4 A64bi ENVIRIIPfu4TAL HEAD PAGE 02 <br /> ,p� r <br /> It1 11 L�\ ' FD JoA UIN COUNIY EHD Loc NUMVLR <br /> SEP 0 8 2003 )ENVIRONMENTAL ALTH DEPARTM- FNT <br /> 304 E Weber Ave 3'0 Floor Stockton,CA 95245 <br /> ENVIRONMENT HEALTR09)468-3420 Fax!(209)4-64-0238 Web: wWW,Co.9an-joaqvin.ca.us/chd <br /> PERMIT/SERVICES P[JBLIC R,�CO REL APPLICATION 14ft7 "am <br /> APPLICANTS Spqj bUSIINESS/AGENGY: <br /> ADDRESS: C)Y`n 1 V nYi v 4=:" <br /> PHONE: O Z�� C�(I AC3IMILE: fi <br /> S— S -90-2 q E:O -Ce--) <br /> TENTATIVE"APPo1NTMEN DAT <br /> (Ploaxa allow 90 business days from data of application submittal) <br /> CHECK BOX TO EXPEDITE RS 993At7>".�-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ DATE -. <br /> oboartmort Use Only <br /> FILE ADORE25S UNIT <br /> V irm - c ID Unit 1 <br /> iso G r) <br /> r- <br /> GpR <br /> Unit 3 <br /> srta, Unit 4 <br /> — <br /> e Unit 5 <br /> 10, S:+r+ <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILESA Ake <br /> AUNDHRGROUND TANK(UST)CLEANUP BITE(LOP) 0 HOUSING ABATEMENT C33000 WASTEFACILITY <br /> a OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> FuNoERGROUNDTANK(MONITORiNGtREMOVAL) ❑ DOG KENNEL a DAIRT <br /> MAZMQOU6 WASTE CENERA-MR ❑ CHICKEN RANCH Q PKG TREATMENT PLANT <br /> G TIERED PERMrgED FACILITY ❑ MOTEL/HOTEL Q PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATT00180DY PIERCING IO POOLISPA 0 LAND USE APPLICATION S TLS <br /> 0 MEDICAL WA5CIE FACILITY 4 OTHER(PLFASE SPECIFY} ...—. <br /> 1. List up to ten addresses In the space above. Select the type(S)of filo$from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. F4x to_(209)_464-Qj3§gr maiLto the <br /> aggrwes indicated Above: <br /> 2. EHD will notify the applicant if Any EHD tiles exist. An appointment for review will bo cnnflrmed <br /> approximately five business days but no tater than ton(10)days after receipt of application. The files <br /> W111 be hold for s maximum of five business days for review. Appointments should ba scheduled <br /> eacordingly. <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 rel*2900 will be reorganized by PND staff at the expenso <br /> of the applicant. Future file reviewS by the same applicant may require a$93.00 deposit prior to review, <br /> S. "FENTATiVE appointment dates roust be confirmed with EHD staff. <br /> 6. Applicatlons received after 8:00 pm will be processed tho next business day. <br /> CONFIRMED APPOINTMENT DATE ----- TIME <br /> I DATE CONFIRMED PHONE FAX INITIALS <br /> F2EVtEW>=D YES Nb T REVIEW DATE <br /> !NO gJAJw - <br /> enrReea <br />