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PAGE 01 <br /> 0 D �N04 r^It,-5E) n4640138 <br /> pJVIROFf�1ENTA1- f£ALTFI Gnu Lw numoort <br /> >AT Z �V LE D SAN JO A.QUIN CoUNTX <br /> El WMONMENTAL$EALTH pEFARTM ENT Ig/3 <br /> MAY 11 2004 304 E Weber Ave 3`d Floor Stockton,CA 95205 ca us/ehd <br /> ENVIRONhryE11�4A'LEl$t3420Fax: (209)464-0138 Web: cosan-joagvi>s• <br /> PERiIMIT/SERVICES PUBLIC RECORDS RELEASE A,pRLZCA�ol� <br /> Bus1NFSSfAGENCY: S • �"`` <br /> !inrt/ C r iK �1 9`ao$z <br /> �APPLICANT: <br /> pODRESS: 3� �Z- I FACSWLE• <br /> HONE: r ✓ Tme:�- y p:oz) <br /> �--�� <br /> `a <br /> TENTATNE"A<'POINTMBNTDATE: <br /> (Please allow t0 pUSinsss days <br /> from date of e.plication submittaq <br /> El CH6CK 00XT0 EXPEDITE RE4UEST'Ssloo FEE—R£4UEST PROCESSED IN 3 BUSINESS DAYS Il�oy <br /> DATE — Af <br /> SIGNATURE OF APPLICANT <br /> Dwarxnem use Only <br /> U <br /> NIT <br /> F11 11 LLE AD11 D11 RESS <br /> sir to 15, w-1 W G 56ak unit <br /> z. s o S W; a 5 k�L 5� <br /> w U<„ <br /> ar. weer <br /> o. sveet 44 <br /> 10, <br /> ENVIRONMENTAL HEALTH DF FILES <br /> ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> US CLEANUP SnE(LOP) _ ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK( T) [3 WD FACILITY DAIRY <br /> OiNER CLEANUP SITE(NON•LOP) ❑ DOG KENNEL ❑ PKD TRFJITMENT PLANT <br /> UNDERGROUND TANK(MOMTORINGIREMOVAL.) O WI=N RANCH C3 pWpFR TRUCKIYARDICHSM TOILETS <br /> YARpOUS WASTE GENERATOR R MOTEIJHOTEL p �D USE APPLICATION SRES <br /> ❑ t�E1tED PERMITTED FACLLI Y 'p pOouSPA <br /> L] TATTOOISODY PIERCING C1 OTHER(PLEASE SPECIM checking <br /> MEDICALwAsTE FAr-LlTy $ of files imm the4-0138 or mail to the <br /> list above by <br /> �- List up to ten addresses In the space above- Select the type( ) <br /> ed. Fax to 2D9 46 <br /> the appropriate box(es). At least one Elle type MUST be selectointment for review will be confirmed <br /> address indicated btive. EHD files exist An appointment <br /> EHD will notify the applicant if any TO days after receipt of application. The 5185 <br /> Appointments should be <br /> sohoduled <br /> approximately five business days but no Later than ten{ ) <br /> will be held for a maximum of five business da for rovle•1 b' immediately available for revlew. A new <br /> accordingly. on by EHD staff may not <br /> 3, Mile that is actively being worked. EHD staff at the expense <br /> application may be sabmrtted when the filo is available. require a$93.00 deposit prior to review. <br /> 4 ion as released will be ri <br /> Any fila not returned in the same conditthe same apps cant may req ani2ed by <br /> of the applicant Future file review's byEHO <br /> 5. NE appointment dates must be confirmed d with the <br /> staff. <br /> 'TENTAT <br /> G. Applications received after 3:00 Pm witl be processed the next businoss day <br /> TIME, <br /> CONFIPMED APPOINTMENT DATE PHONE FAX INITIALS -- <br /> DATE CONFIRMED REVIFW DATE <br /> REVIEWED <br /> YES NO <br /> EHD 45.Cc-006. <br /> 90099L90E9 94:bT 700L/TT/90 <br /> 0/T0 30Vd 3I-1V0 ON snivdis <br />