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• g{O LOG 14UMSER <br /> SAIL JOAQUIN COUNTY <br /> NM0NIISEI UAL HEALTff DEPARTME}_`T <br /> 304 E �y�er Ave 3 d Floor Stockton,CA 952u0jLc&ush z> ZZ <br /> NOV 0 9 20n q . 209 464-0135 Web:www'w° m-}oaq l <br /> (2b9)46&3.420 F'as.( ) <br /> ENVIRONMENT HEALTHP ExC CQ�s jgLEASE.APPLICATION <br /> PERMIT/SERVICES F1A F-� <br /> BU '�S <br /> �pr(t,i �ljlaiv�t SINEMAGENOY; �1t5g7 <br /> ApPucANT: `17ia��o •Sc,l�e 2ofl WArn�'E C�cek Ul <br /> Ca. <br /> ho <br /> gppRess: 2 5 l� r 28 FACSIMU-E: (-25) 5 3 - 6!2 f <br /> PHONE: f°iz5 a83-6dU0 K <br /> Tana:------ ----- <br /> TENTATr4E"APMN=Wr�Y <br /> . Iplaasa allow 7o ydslnas6 day+hwd data OtaPPrnStIM° i <br /> �yQ • 3-CD FEE-RE4 / OCES$ oiH3BUSNIESS OAY5 <br /> ou? _ D <br /> ATfiCHECK gOXTO pCPE06REQT � <br /> p�,aeynenf use OMY <br /> SIGNATURE OF APpu�T <br /> URR CC <br /> west Y,0r 11e i'I N " M�+era <br /> We5f ",+f Avinu ❑ Unit2 1 \p\ <br /> ` Unit3 \\\ <br /> 6 S°" tliiit4 <br /> p unit 6 <br /> e. Y� <br /> B_ six, <br /> 10. SPzt t <br /> ENVIRONMEHTAL HEALT14 D1 PARTMENT FILES <br /> / b HOUSING pBATEMeNT 0 SOtlo WASTE FAGu'rY <br /> P� NUERGRDUND TANK NsY}GI uP S[r6 0.0Pi O IFtl00 FACII.ttY t7 SOUO WASTr VEHICLE <br /> l�/��O SITE(NON-LOPI ❑ bMt'� <br /> 6( VNoERGIt lA7 T{WK(NONITORRtG7REdI0YAR) O WiIGKEN RANCH L] PKG TREATSIr <br /> �Np•?gRpCUS WASTE Gt71ERAT� b PUMPER'rRUtwUYPitCKMAR 0/CNEM S0ILBTG <br /> O [tEREU PeRMITTEn FAGIl1T�• p MOT£1nioTEt �A Oter P^�E LW)e 4 f i*0 �• e^ <br /> O TATrOCl6OGY PIERCING OTHER(PLEAse sPECIFYI_._--- chocking <br /> MEbICAI WASTeFACILTTr sof fitesfrom the,list above hY <br /> in the 8 ace above. Select tile,type( ) <br /> 464.0t36 Or mail to the <br /> t- List up to tan addresses P MUST 6o selected. ax to z09 <br /> the apProPrte box(es). At Least ono file type <br /> address Indicated above. EHD files exist An appolntmenf for review wlN bo confirmed <br /> awpipll rboaxihmealdtef]oyr <br /> taihme baxuismrinouamntOITf faivney'business days for revi nelcatThe <br /> files <br /> 2- scheduled <br /> �•bAp ed aEely available for review. Anew <br /> accordingly- worked on by EHD stall may' <br /> 3 A lila tiiat is actively being <br /> application may be submitted when the file is available. anized b EHP staff at the expense <br /> the same applicant may require a X93.00 deposit prior to review. <br /> 4, Any file not�L f=uture tie t�•eviews by on as released will be reorg <br /> of the app Intment dates must be confirmad with en. staff• <br /> 5_ 'TENTATIVE appo after s:90 Pei will b® roceased the next business day. <br /> 6. APPiiwtions receNed P p <br /> TIME �"•��� �r ..f- 1 t <br /> POIr1TMEii7 PATE <br /> phlflRMEQ Ap .. <br /> FAX-.- :.: IPtt?IlAt S —' <br /> z� �PkIONE : • <br /> DATE C6XF1 MED <br /> REVIEW DATE. <br /> .,.VHS NO <br /> �j�t?�IEWED ' <br /> �aaxvas 8ET0V9b 9S=Z't 400Z/60/T't <br /> p Zg 3dtld Hl-1i3H �tl1N3693J'JIM3 <br />