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DEC-13-2004 12:53 CONDOR EARTH TECH 209 532 0773 P.01i0' <br /> PATE RECEIVED EHD LOG N <br /> NUSAN JOAQUIN COUNTY <br /> - .J <br /> E ` 'MONMF `d AL it r'A}.I H DE.[11R1mm 1 <br /> DEC 1 ;3 2004 304 E Weber Ave 3`'Floor.Stockton, CA 95205 <br /> (209)468- 420 Fax: (209) 464-0138 Weh: www.co,saIa joaqum.ca-us/ehd <br /> ENVirUi'i . ,.,. : U.n'111 <br /> L <br /> PE 9, [-fi R _ES �UBLIC RECORDS ML]EAS-E APPLICATION <br /> eel <br /> APPLICMT; BUSIMESSIArGENCY: <br /> AnDRESS: <br /> PHON — FACSIMILE Q �r <br /> TENTATN> `APPorNTM ENT aarE 1ecew� � 'J1�Qn n <br /> (Please allow 10 buslnwm days from date of appl!catlon submittal) <br /> CHECK SOX To ExPEDrrE hEour T-$93.00 FEE--REGUF_ST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Usa only <br /> r1r F AbDRE5S NIT <br /> •i <br /> t s Por aG F-3Unit 1 <br /> z sh.e' 8(, '� <br /> 3. so-vx "4 ; <br /> MyUnit2 <br /> s suede <br /> OV r4L4 M rUnft6- sneer PENT�I� � v7. sweet ON t�TAAI IRPbI� r v , <br /> N T'o v1 Co, (r0+ cTaI2 cyx-(561 5 Air, f-+ �L°y <br /> e. s�ee1 (0N u lc- RAtt_Rc�+ 1 '� Yl�t �r Units <br /> �o. sweet <br /> ONAMA <br /> I <br /> ENVIRONMENTAL HEALTH DEPARTMENT FIDS <br /> kf UNDERGROUND TANK(UST)c4muP srrE(LOP) 0 HOUSING ABATEMENT SOLID WASTE F Ila% <br /> ' <br /> OTHER CLEANUP SITE(NON-LPP) ❑ FOOD FACILITY t SOLID WASTE <br /> UNDERGROUND TANK(MON7TQRINolREMOVAL) L] DOG KENNEL DAIRY Y <br /> HAZARDOUS WASTE GENERATOR 4P CHICKEN RANCH d ; <br /> PICC TREATMENT PLANT <br /> -nEPED PERMn'TED FACILITY 0 INOTELMOTEL 0 PUMPER TRUCKIYARDICHEM T0U_E7S <br /> Q TATToo/BODY PIERCING D POOL/SPA J2�LAND USE APPLICATION SnES - <br /> M' MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPE <br /> 1. List up to ten addresses in the spade above_ Select the type(s) of files from the list aboye py checking <br /> the appropriate bo#e r)_ At least one file type MUST be selected_ Fax to (209) 46"138 or mail to the <br /> address Indicated gbove. <br /> 2. EHD will notify the pplidant If any EHb files exist, An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10) days after receipt of application_ The files <br /> will be held for a m mum 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 no, <br /> application may be Obmittod when the file Is available. <br /> 4. Any file not retumed in the same condition as released will be reorganized by EHO staff at the expens <br /> of the applicant. Future file reviews by the samo applicant may require a$93_00 deposit prior to-reviel <br /> 5. 'i ENTATIVE appointment dates must be confirmed with EHD staff, <br /> 6. Applications recely*d after 3:00 pm will be processed the next business day. , <br /> PONFIRMEDAPPdltTutr; TAAT TIME :rFs ` <br /> DATE CONFIRMED 'PHONE FAX )NITIALS <br /> REVIEWED YES NCI REVIEW DATE <br /> TOTAL P.0' <br />