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03/17/04 15:54 FAg )}�# 0 001 <br /> EHE)LOG NUMBER <br /> SAN JOAQC3IN COUNTY <br /> ECCT <br /> SVIRONMENTAL HEALTH DEPARTMENT <br /> MAR 17 2004 304 E Weber Ave 3`d Floor Stockton,CA.95205 <br /> (209)468-3420 Fax: (209)4&40138 Web: www,casan Joaquin-ca.us/I <br /> 13 . <br /> tif�VlRllldlsERV10ES <br /> PUBLIC RECO <br /> PERM;.! RDS"LEASE APPLICATION <br /> BUsINESSIAGENCY: <br /> i) <br /> APPLICANT: <br /> ADDRESS; 7 j I �• <br /> p 0 ?�2SY <br /> PHONE: �- ` � � O FACSIMI <br /> TENTATIVI=*APPOINTMENT DATE, Time: <br /> (Please allow 10 buslnass days front data oflappllcat'"submittal) <br /> I <br /> CHECK Box To EXPEDITE REQUES $93.00 PEE w RE U ST PROCESSED IN 3 BUSINESS DAYS a <br /> DATE <br /> SIGNATURE OF APPLICANT Papartmerd UI Or* <br /> UNIT <br /> FILE ADDRESS <br /> Unit 1 <br /> t. SueI <br /> . U �l <br /> s t a I Unit 2 <br /> I. 8dce1 <br /> O <br /> e, StrCeL I Unit 3 <br /> r <br /> SWAT <br /> G <br /> 6 1I Unit4 <br /> 7. SOW <br /> Gl <br /> Unit 5 <br /> 10, stsevl <br /> ENVIRONMENTAL HEALTH DEP,,ARTMENT FILES j <br /> SOLID WASTE FAC! 75, <br /> I <br /> UP SITE(LOP) HOUSING ABATEMENT L E <br /> uNDEI;GROUND TANK(UST)CLEAN FOOo FACILITY SOLID WASTE VEHIC <br /> OTHER CLEANUP SITE(NON-LOP) CK DAIRY <br /> UNDERGROUND TANK(MONTrORINGIREMOVAL) DOG KENNEL_ PKG TREATMENT PLANT <br /> lig-HAZARDOUS WASTE GENERATOR XL CHICKEN RANCH pUMPER TRUcXfYARDICHHN TOILETS <br /> kr TIERED PERMITTED FACILITY 0-IMOTi=J.JHOTELI IiL LAND USE APPLICATION SITES <br /> TATTOoIELODYPIERCING 0 PA <br /> MEDICAL WASTE FACILITY ❑ OTHER THER(PLEASE SPECIFY) <br /> !. List up to ten addresses in the space alcove. Select the types)of les from the list above by checking <br /> the appropriate box(es). At least one file type MUST tie selected. Fax toFax to(2 g9 138 or Irta' to e i <br /> address indicated above. I oirltrnent for review will be confirmed <br /> 2. F-HD will notify the applicant d any ENDbut <br /> n files exist. An app lication. The files <br /> approximately five business days but no Eater than tees ie days oigftntments should be scheduled <br /> will be held for a maxlmurn of five business days for review. App <br /> accordingly. I <br /> 3. Afile that is actively being worked on by END staff may not be immediately available€vr review, new <br /> application may be submitted when the file is available. the <br /> 4. Any file not returned In the same condi#ion as released will be reorganizedeqrra 93 00 dleposit Prior t rev ew. <br /> of the app ltcant may req <br /> applicant. Future file reviews by the carne apps <br /> 5. *TI=NTATIVE appointment dates must be confirmed with EHD staff• _. <br /> 6. Applications TO after 3:00 pm will be procasse the next business day. f4y, , As" <br /> .. <br /> CONfi{RMED'APPOINTMENT DATE I TIME <br /> DATE CONFIRMED <br /> PFfONE FAX, <br /> REVlE1N.6D YES NO' kENIEw D'A-rE' <br /> Eta aagZaue <br />