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JUL 0 3 2000 <br />ENVIRONMENT HEALTH <br />PERMIT/SERVICES <br />APPLICAXT � ----SUSiKESSIAGENCY <br />SAN JC UIN COUNTYPUBI-IC HEALTH SE GES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR / <br />STOCKTON CA 95202 <br />(201) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICA ON <br />ADDRESS <br />pl"ONE <br />FACSIMILE r- <br />TENTATIVE'` APPOINTMENT DATE TIME _ <br />(Please give 7 to 10 business days from date of application submittal) <br />CHECK BOX TO EXPCOtTE REQUEST- $79.00 FEE — REQUEST PROCESSED IN 3 BUSINESS DAYS r <br />DATE <br />GNATlJRE OF APPLICANT <br />ENVIRQ�iMENiAL HEAL -T. tJIVISION FILES A <br />❑ HOUSING AUATEMI=NT 0 SOLID WASTE FACILITY <br />0 OTHER CLEANUP <br />'TAMC {UST} CLEANUP SITE (LOP) ❑ FOOL) FACILITY ❑ SOLID WASTE VEHICLE <br />❑ OTHER CLEANUP 517E [NON -LOP) VA <br />G UNDERGROUND TANK �MONFTORIFiGIRp DOG KENNEL O DAIRYEMOYAL) M CHICKEN RANCH p PKG TREATMENT PLAKT <br />C HAZARDOUS WASTE GENERATOR C MOTELJFIOTEL 0 PUMiPER-tRUCKNARDIGHEM TOILETS <br />u TIERED PERMFTTEO FACILITY p OTHER t O LAND USE APPLICATION SITES <br />C TATT00J600YPEIRCING a PBUCWATER SYsT> hR PLEASE SPECIFY ABOVE) <br />C MEDICAL- WASTE FACILITY GI pU81JC W <br />List up to ten addresses in the space above. Select the type(S) of files from the list above by checking <br />Inc appropriate bOX(es). At least one file type MUST be selected. ail to the <br />addreSS indicated above. <br />2. EHD will notify the applicant if any EHD 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 maximum of five business clays 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 new <br />application may be submitted when the file is available. <br />4. any file not returned in the same condition as released will be reorganized by EHD stfifF at the expense <br />of the applicant_ Future file reviews by the same applicant may require a $78.04 deposit prior to revlew. <br />5. 'TENTATIVE appointment dates must be confirmed with EHD staff - <br />6. Applications received after 3:09 pm will be,processed the n$Xt business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />i <br />ATECONFIRMED PHONE FAX INITIALS <br />�EVIEWI:D Y� N� REVIEW DATE ___ — i <br />TOTAL P.01 <br />yHIS SIDE @Hd STAFF U$E ONLY <br />FILE AbDkL�SS <br />PROGRAM ELEMENTS STARCH <br />p$ <br />W. (-k41r-tw Way,ZkTon <br />52ro l�l� 7'' <br />I1�4DILA ST. &-toA <br />`1 S <br />5z <br />2�5f I 2Z� , Zu <br />t -f Co 5i. " <br />L� <br />6 <br />I <br />W, t r <br />?. L <br />>� �,� <br />X35• I <br />3�Z(, <br />35 �v <br />5 15 <br />W Gkar tt✓ W " <br />3 <br />r-4-- <br />23 Ql <br />a3g1 <br />Z <br />3G <br />Is►Vut, <br />u <br />�f <br />—C �,.>ti <br />a1..,.+k tn��r�r' Strr�T. <br />5't�Gkt <br />�S•.Z� <br />�A <br />ENVIRQ�iMENiAL HEAL -T. tJIVISION FILES A <br />❑ HOUSING AUATEMI=NT 0 SOLID WASTE FACILITY <br />0 OTHER CLEANUP <br />'TAMC {UST} CLEANUP SITE (LOP) ❑ FOOL) FACILITY ❑ SOLID WASTE VEHICLE <br />❑ OTHER CLEANUP 517E [NON -LOP) VA <br />G UNDERGROUND TANK �MONFTORIFiGIRp DOG KENNEL O DAIRYEMOYAL) M CHICKEN RANCH p PKG TREATMENT PLAKT <br />C HAZARDOUS WASTE GENERATOR C MOTELJFIOTEL 0 PUMiPER-tRUCKNARDIGHEM TOILETS <br />u TIERED PERMFTTEO FACILITY p OTHER t O LAND USE APPLICATION SITES <br />C TATT00J600YPEIRCING a PBUCWATER SYsT> hR PLEASE SPECIFY ABOVE) <br />C MEDICAL- WASTE FACILITY GI pU81JC W <br />List up to ten addresses in the space above. Select the type(S) of files from the list above by checking <br />Inc appropriate bOX(es). At least one file type MUST be selected. ail to the <br />addreSS indicated above. <br />2. EHD will notify the applicant if any EHD 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 maximum of five business clays 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 new <br />application may be submitted when the file is available. <br />4. any file not returned in the same condition as released will be reorganized by EHD stfifF at the expense <br />of the applicant_ Future file reviews by the same applicant may require a $78.04 deposit prior to revlew. <br />5. 'TENTATIVE appointment dates must be confirmed with EHD staff - <br />6. Applications received after 3:09 pm will be,processed the n$Xt business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />i <br />ATECONFIRMED PHONE FAX INITIALS <br />�EVIEWI:D Y� N� REVIEW DATE ___ — i <br />TOTAL P.01 <br />