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GATE RECEIVED SAN JOAQUIN COUNTY <br />L L �`J lS U ENVIRONWiFNT 'M DFPARTMENr <br />304 E Weber Ave PFloor Stockton, CA 95205 <br />0 C T 0 4 2004(209) 468-3420 lax: (209) 464-0138 Web: www-co.san joaquin-ca-us/ehd <br />ENVIRONMENT HEALTH PUBLIC RECO E APPLICATION <br />PERMITiSERVICE <br />APPLICANT: D BU.SINEWAGENCP <br />ADDRESS: <br />PHONE: �r CSD FACSIMILE: <br />rTEN-rATim AppowmENT DAm,., <br />(Pieria aliaw 10 busioew dap ftm date of application submittal) <br />® CHECK BOX TO EXPEDITE RE EST • 593-W FEE - R4QUtST PR SED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT .� DAT E AJ -0 <br />DaparkneM Lbe Oidr <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNIT <br />❑ Unit 1 <br />❑ Unit 2 <br />❑ Unit 3 <br />❑ Unit 4 <br />❑ Unit 5 <br />O UNDERGROUND TANK (U q CLEANUP SITE (LOP) d HOUSING TEMENT <br />a sou®wasT>= F <br />D SOLID WASTE <br />D OTHER CLEANUP SITE (NON -LOP) 0 DAIRY <br />E3 UNDERGROUND TANK (MONITORINGlREMOVAW L <br />D PKG TREATMENT PLANT <br />O HAZARDOUS WASTE GENERATOR a Mo C PUMPER TRUCrJYARWCHEM TOK2Ts <br />Q TIERED PERMITTED FACILITY .O POOLJSPA 0 LAND USE APPLICATION SITES <br />0 TATTOOIBODY PIERCING • a OTHER VIEASESPEC1F1r) <br />93 MEDICAL WASTE FACILITY <br />1. List up to ten addresses in the spate above. the typesi of files from the list above by eheddng <br />the appropriate box(es). At least one file UST be selected- Fax to (209) 464-0138 or mato the <br />address indicated above - <br />2. EHD will notify the applicant if any EHD files ISL An appointment for review will be confirmed <br />approximately five business days but no later n ten (10) days after receipt of application- The files <br />will be held for a maximum of five business for review. Appointments should be scheduled <br />accordingly. <br />3. A file that is actively being worked on by EH15 staff may not be immediately available for review. Anew <br />application may be submitted when the file is available. <br />4. Any file not returned in the same condition as released will be reorganked by EHD staff at the expense <br />of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review <br />.5. 'TENTATIVE appointment dates must be Confirriled with E;HO staff. <br />6. Applications received after 3:00 pm will hd processed the next business day. <br />dONFIRMED A00bINTMENT DATE TIME <br />PATE CONFIRMED PH <br />`ONE `INITIALS <br />REVIEWED YES NO REVIEW DATE: • <br />16f i��,�VlA9 <br />lCl <br />