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f'Sent By: BASELINE; 510 420 1707; Jun-22-05 2:39PM; Page 1 /1 <br /> --n - b'lqwa 14�, <br /> VVV/E D EHD LOG NUMBER <br /> LLSAN JOAQUIN COUNTY <br /> J" 2 2 7n05 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 Fast.Weber Avenue,3nd Floor,Stockton,CA 95202-2708 <br /> EWRONMENT HEALTHTelep`ave:(209)468-3420 Fax:(209)464-0138 Web:.www.sjgov.org/chd <br /> PERMiTISEMACES �! <br /> PUBLIC RIGORDS,RELEASE APPLICATION <br /> APPUDAMI': 60closs BUSINESSIADENCY: <br /> ADDRES"; 10 ito,lat S'.3M4 slits 1 11 c5m -t 9 L/638 <br /> PtlOrff(,)e - 1:k '/ L�,Zd'-�•� �ACSIMILE: <br /> TEN ATIYE-aPPOWTtllifif0 71t- ±W. .. Time: ("Al; <br /> 2'{ a. •� t,%+e <br /> (pj a ■um.70 DualnRse Aaya aela deb of oppikedw subnMt ll-•Tw&fha only-must U"n ;M <br /> ' )(CHECK BOX TO EXPEDITE REQU1 8A0 (CA$H Oli CHECK ONLY)-REQUEST PROCESSED IN 3 B INESS DAYS <br /> :. . .SIGNATURE OF APPLICANT DATE t Z i3S <br /> ANaT DIeTPo(tUTgN . QV,gt.t ...G,. Uen Unit Munfta 0 Unha G Dow J.Wctronclity lrllt.M,RmePa) <br /> FELE A EHD USE ONLY <br /> se..te <br /> fluent lines f- <br /> A. <br /> 0. lin U11LU111 Ii <br /> 0. .. . . <br /> t0. _. . <br /> Specific Date Ratgla of hdonnation 9squoiMd-Fram.. m , <br /> t"061 1 l-HEALTH DEPARTMENT FILES h F <br /> XLbMAGROUND TANK JUST)CLeANUP SM(LOP) 0 Houmr.AsATEvPw 0 aouD WASTE FAOLI YNEMCLE <br /> A CLEANur&iEJNM-LLP) ❑Food FAczuTy 13 WASTE TIRE _ <br /> �IO TAN1GICK ATOR fRENOWJ.) 0 nos eNRA E3 DAIRY <br /> HAUWDOUE WAbTeOer¢MTpt -O CFID/{EN rtAMr,H E3 WASTEWATER TREATMENT PUNT <br /> 17 TeEren PEaM DFACILm 0MoTEUHOEO PUMPR TRUddYAH07CHEM T <br /> OILETS <br /> 13 T ODY NeaaO P00II,A 0 LAND USE APLICATX/Sn <br /> O MEDICAL <br /> WASTE FACILITY 0 OtHeR(PLEASE SPraF'rt <br /> WELL ANDSEP=PERMIT RE00RDG ARL AYNLAKE FOR R"M- MONDAY;MDAY 8:00 AM4:OOPM - EMUAMNO HDIDAYS. <br /> 1. List up to ten addtessss In the apace Itbeve. weathe types)of files from the list above by checking the <br /> appropriate box(ea). Atteast one file Viia iYKJST be selected. Faxes(208)484-01s8 or mail to the addrese <br /> Indlcat»d above. 'Address ranges Will not be accepted-for,additional assistance with file addresses,contact <br /> the EHD-Applications received atter 3:00 pm will be processed the next business day. <br /> X The EHD will nottly,the appllcagt N any EHD files exist. An appointment for review will be confirmed <br /> approximately ten(10)days after receipt of application. The files will be held for a maximum of five business <br /> days for review. Appointments should be scheduled accordingly. <br /> 3i 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 conditionas released will be reorganized by EHD start at the expense of the <br /> applicant Future file reviews by the same applicant may require&S03.00 deposit prior to review. <br /> laieo+Raa -....'-- <br /> Nswe <br />