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01/15/04 THU 12:46 FAX 192#2029 SHAW E & I • zoo <br /> PAGE 02 <br /> •0:/15/2004 10:39 4640138 <br /> ENt1IRONMENTAL HEALTH Cnu w��•�•••`.. <br /> SAN JOAQ� COQ <br /> DATE RECEN��ED 1 _�{- ITA 'JUALTH pEPARTWn L E <br /> G3 EC[ V ,f E�� ESO ve 3 Floor Stockton,CA 95205 <br /> 304 E Weber A 00.san joaquin.ca <br /> JAN 15 Zr$69)468-3420 Fax:(209)464.0138 web. VVM <br /> ENVIRONMENT HEALTH �i �LIC LECOPDS ByLEASE IMLICATION <br /> PKOD A M A(;-YS BUSINESS/AGS CY' 4 9 5bt0 <br /> n,,,�,o r �` <br /> d <br /> APPucANT: <br /> gpDRESS: � '2 <br /> FpCS{Mtt.E= <br /> HONE: a5 a g Z Z,93 Time: <br /> �a <br /> TENTATIVE-APPOINTMFNT DATE: � of a Kation submittall <br /> from date p� i \I d" 'g7o—+F <br /> (please all**10 business days l <br /> REQUEST PROCESSED IN <br /> 3 Bt1SINESS DAYS �5 �- <br /> -- G� <br /> EDITS REQUEST"593.00 PEE- DATE <br /> Q CHECK BOX TO EXP Gt/1 n/� mt use Only <br /> iGNATURE OF APPLICANT 1 1 t UNiT <br /> LF ADDRESS <br /> A�DF.ti ° <br /> pes)C't Ghmp V Unit 2 <br /> 1. sh"N 3 3 3 Ma <br /> 2 Sfre <br /> p unit <br /> ` u Unit 4 <br /> s. s�rea <br /> s. sant Una 5 <br /> T. G Q <br /> e. S1reEl <br /> g• Street U <br /> 0. s TH DE.PAICTMENT FiLES <br /> EN�RONMENTAL t1EA1 SouDWASTE,FACIL" y_ <br /> • ❑ I•IoUStNGA�ENT d SOUD UDwAneVEHICLE <br /> UNDERGROUND TANK(tlSY1 CLFALJUP SiTE n.41� ❑ pgp0 TMVNT PLANT <br /> t3 OTHER CL L"Up SITE(NON-LOP)NGIREMOViW ❑ 'KENNEL Q PKQ TREA ICHEM TOit ETjS <br /> ❑ CHICKSH W D PW jp�USE AP TTIION SMS / <br /> Cl UNDE,A ppUS W TE GENB�R <br /> p POS prE1 <br /> _ i7 T PERMtiT60 FACILITY p OTHER(PLEASES cheOlCin ; <br /> G TATTOOIBODY PI£RCMd a list aboYO by . <br /> p MEDICAL WASTE FACILITY a geld the typetsl of fillies frotn`th 4 , 138 or 'Hari o the . <br /> ace a 0 t • MUST be selected. Fax to �0 <br /> 9. List up to ten address IA east one file type review will be confirmed <br /> thv approprlate bOX( )• An appointment receipt of applyhon. The file <br /> address 1 dicated as°Ilcant if any DID files extst. <br /> 2. EHP will notify thepp for view. Appointments should be scheduled <br /> five business days bu s Hess days n tee(10)days after' <br /> approximately available for review, A n <br /> aXintum of five bu <br /> yvlil beheld for a rn not be immediately <br /> accordingly- worl(ed on by EHD staff inaY <br /> A file that is actively being anized by F-HO staff at the expel <br /> 3• a be submitted when the' is available-wiil be reorg sit riot to rev <br /> application m Y (icant may require a IsS3-00 deposit P <br /> Any f l® learic <br /> not returned inthe le reviews bythesame d�EHD , <br /> a• applicant- Future must be cor+ffn►' <br /> of the ,tV S appointment dates m rocessed the naxt business day' <br /> 5. *TENTH m will be P <br /> 6. Applications received atter 3:00 p 71ME <br /> . _ ITIAL S ._----- <br /> CONFIRMED APPOINTMENT DATE pHONE. - FAX IN <br /> DATE CONFIRMED NO REVIEW DATE. <br /> REVIEWED YES <br /> CHI) OOi <br /> WLMO03 <br />