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Ir 07/29/2005 10:25 FAX 209 948082 <br />Z002 <br />�I� GnV w.a ..vnw�n <br />° WMV ISD SAN JOAQUIN COUNTY <br />DNVIRONIVIENTAL M+ ALTH DEPARTIVCENT <br />JUL 2 A 2005 304 E Weber Ave 3 rd Floor Stocktonw; C .95205 1 <br />(209) 468-3420 Fax: (209) 464-0138 Web: ww_co.san Joaquin-ca_usland I U <br />ENVIRONMENT HEALTH <br />PERMIT/SERVICES \ p()BLIC RECORDS RELEASEp/APPLICATION <br />APPLICANT: tir' v"S BUSINESSIAGENCY: <br />�. <br />yST <br />NST <br />ADORES$: <br />PHONE: <br />rc,,,'...iw ....-._- _._ `. r <br />(Pleaze allow 10 business days rrom date of application submittal) <br />❑ CHECK BOX TO EXPEDITE REQUEST - 59100 FEE- REQUEST PROCESSED IN a sUSINES5 DAYS LS ZFx�s <br />DATE <br />SIGNATURE Of APPLIGAtl1 Lent use Only <br />'trtwttvnmcn r rr- ..�^--• • • -__ _ _ -.... <br />UNIT <br />0 Unit 1 <br />Unit 2 <br />-Unit 3 <br />Unit 4 <br />❑ unit <br />s <br />AsATEMFW <br />I�. SOLID WASTE VEHICLE UNDERGROUNOiANK (UITE ST) CLEANUP S{LOP) ❑ HOUSING ❑ sOUD wASTE VEHICCLEE <br />OTHER CLEANUP SITE (NON -LOP) ❑ POOO FACILrrY I3 DAIRY <br />M UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL I!LPKG TREATMENT PLANT .0 <br />ffi HAZARDOUS wASTE GENERATOR ❑ CHICKEN RANCH <br />❑ T1ERE0 PERiAM-EO FACILITY ❑ MOT9LIHOTEL ❑ PUMPERE APP UYA-nOH SIM TOILETS <br />❑ POOUSPA LAND USE APPLICATION SITES <br />❑ MEDICAL WA.S PIERCING G OTHER (PLEASE SPECIFY) <br />❑ MEDICAL WASTE FACR.rTY <br />1, List up to ten addresses in the space above. Select the type(s) of flies from the list aboye by checking <br />the appropriate box(es). At least One file type MUST be selected. Fax to 209 46d-0138 or mail to the <br />addressindicated above. ointment for review will be confirmed <br />2. EHD will notify the applicant if any EHD files exist An app <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 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. ne <br />application may be submitted when the file is available. <br />4 Any file not returned in the same condition as released will he reorganized by EHD staff at the expense <br />of the applicant_ Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 3:00 pm will be processed the next business day. <br />"y TIME <br />GF(RME <br />ON........: A??OINTMENT. ATH'' -: <br />pATE.CaNFJRMEp ..PHONE . FAX' -;':1{Y,•. .. N1Gl¢L$ <br />REVIEWED YES NO P.EVIEW DATE <br />