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03/04/2004 12:48 6369399-57 HERST & ASSOCIATES PAGE 011,2 <br /> 11/12/2003 11:25 46401 ENVIRONMENTAL *H E <br /> �I�� 1 <br /> ." 11 Plu..,. <br /> DATE RECEIVED SAA SOAquiiN COi]NTY V V <br /> E oNjmxN+-�rAL HEALTH DEP,RTMNr MAR 0 4 2004 <br /> 304 E Weber Ave 314 Floor Stockton,CA 95205 E ONN)b <br /> w <br /> (3 <br /> (209)468-3420 Fax:(209)464-0138 Web:ww.co.san jvaq*ca.uv f Mlps q! hLA I H <br /> pUBLIC RECORDS RELEASES lAPPLICATION <br /> APPLIcaNT. _ <br /> ADDRESS: <br /> KOMI-* f FACSIMILE*. <br /> If�[�. '�O d.•ft/�t Q�.ufii/Jl � Cc3'G�-�C <br /> TENTATIVE*APPOINTMENT DATE: nd� 07 Time: <br /> (please allow 1D h9 days tbm date of appl(ca1;IQh aul�mmaly �� �; c.; <br /> CHECK SOX TO STEDI M FIE HEST- 3.D0 FEE �T P SED IN x I�1ISINESB DAYS <br /> .VSIGNATURE OF APPLICANT DATE <br /> Deperhneflt use 0M1r <br /> ME�1DORESs UNIT <br /> c, ❑ Unit 1 <br /> r72 > <br /> a <br /> A. �o-eei ` r:, Unit 3 C i <br /> C;t <br /> e. s eet Unit 4 <br /> f <br /> t. a <br /> a ❑ Unit 5 � <br /> 9 <br /> 10. Slm� r� l J <br /> ENVIRONMENTAL HEALTH'DEPARTMENT FILE-2 <br /> MENT �SOLIO WASTE FACILITY <br /> UNDERQROiUND TANK NST)'I.EANLIp SITE�"4� p FOOD p HOUSING NG ABATE Q SOLID WASTE VEHICLE <br /> X OTHER CLEANUP SITE(NON-LOP) IUTY E3DAIRY <br /> E <br /> NPOtOROUND TANK[MONITGRINGJfiI=MGYA4y C 1q�N RANCH C1 PICA TPAA TENT PLANT r� <br /> AZARDOUS WASTE GENERATOR Q MOTELARML. ❑ PUMPERTRUCK/YAROfCHEM 70tL <br /> I£R1=G PERMITTED FACILITY ❑ POaLlSPa )KI.M0 USR APPLJOATION SITES �1/L�� <br /> ❑ TATTOOGIOD'Y PIERCING ❑ OTHER 0MRASS SPECIFY} <br /> ❑ MEDIC&WASTE FARIL MY <br /> 1. List up to ten addresses In the spans fibova. MUST be rejected. FOf . tao209 a 146 -�ist 1a8 e Py checking <br /> the appraj)02te box(es). At least tYP <br /> address Indicated above. <br /> 2 P110 will notify the applicant if any EHD filem exist. An oppoipunant;for review will be confirrnThe e <br /> approximately five business days but Ott dayls foretn¢vlewd Appo�tmeIotx shouldpbe Scheduled fil� <br /> will bo hold for a maXimunt Of fcve <br /> accordingly not be IcnmadiatL►fy available for review. Anew <br /> 3, A floe that is aatively bs�lttg workad on by EHD Staff May <br /> application may be submitted when the file is avallalbla. be_ ized <br /> a, Any fila not returned In the same iws y the seen 1 applicant may require a$9300 deposit prior to reviewE14D stafl,at the e <br /> of tine appllcgntr Future file re alt <br /> 5, *TENTATIVE appointment dates mustlb b�Processed the next business day., <br /> Applications received after 3:00 pct — <br /> CONFIRMED APP61 <br /> tJii MENT DATI~ TIME ----�P�-'Fax Note 7671 <br /> PHONE FAX (� <br /> DATECONFIRMED ' &J-Dept. <br /> RAVII_1NED <br /> YES NO REVIEW DATE Pn«�# <br /> EMP -OZ49. FaX 0 R J <br /> areuoaa o �tiL . <br /> +76%,-o <br /> 3 <br />