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07/29/2005 10:25 FAX 209 948081' / .0 002 <br /> �I M� CfIV"Iu I�VmV., <br /> SAN JOAQUTN COUNTY <br /> v ENVIRONNIENTAI.MALTS AEFARTNCENT <br /> JUL. 2 9 2005 304 E Weber'Ave 3'd Floor Stockton,CA 95205 <br /> 209)) 468-3420 Fax: (209) 464-0139 Web: www-co.sanjoaquin.ca.us/chd I <br /> ENVIRONMENT H�AL1H <br /> PERMIT/SERVICES '-pUBlLIC RECORDS RELEASE <br /> q�A FLICp SATION <br /> APPLICANT: <br /> HUSINESSIAGENGY: f l& <br /> ,J <br /> ADDRESS= r1 <br /> rd- '-( FACSIMILE: 2-` <br /> PHONE: Ce <br /> y,," <br /> TENTATIVE'APPOINTMENT DATE: .� I Yr Tune: <br /> (Please allow 10 business days from date of application submittal) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST•$97-00 FEE-REQUEST PROCESSED IN 3 BUSINEaS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> pa Use Only <br /> UNIT <br /> FlUe ADDRESS <br /> nJ F ,� ti G S ❑ ' unit 1 <br /> �Unit Z <br /> uST�� s. svea -k /Unit 3 <br /> T-t e. sv«r a <br /> Unit 4 <br /> 1. sum dam <br /> �- $''�' `� ❑ Unit 5 <br /> G _ I'XLLLJ) <br /> f- Sid <br /> ia. aeec� 2 <br /> ENVIRONMENTAL HEALTH DEPARTMENT Fl� �' S <br /> O <br /> UNDERGROUND`rANK(UST)CLEANUP SRE(LOP) Cl HOUSING ABATEMENT C SOLID wAsTE FACILITY <br /> ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP sere(NON-LOP) ❑ P000 FACILITY M DAIRY <br /> M UNDERGROUND YANK(MONITORINGIREM OVAL) 0 _DOG KENNEL <br /> 1111-PKG TREATMENT PLANT <br /> ffi IiAZPIiDOUS WASTE GENERATOR 13 CHICKEN RANCH[3 MOTEWHOTEL ❑ PUMPER YRl1CK!'fARDfCHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOLfSPA da LAND USE APPUCAYION SITES <br /> ❑ TAIToomooY MERGING CI OTHER(PLEASE SPECIF'n <br /> ❑ MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list aboye,by checking <br /> - the appropriate box(es). At least one file type MUST he selected. Fax to 209 464-013a or mail to the <br /> address.indicated above. <br /> 2. EHO 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 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. Ane <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 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. "TENTATNE appointment dates must be confirmed with EHO staff. <br /> 6, Applications received after3:00 pm wilt be processed the next business day. . <br /> :TIME <br /> CONRIRIvIE ar.;r �J;:• _:'.i1:ri=;P.'' FI: <br /> O APPOINTMENT7JATE <br /> ,'DATE. `gNF.IRfi�EO ...•.PHONE . "FAX'" _•'• �;;� ;;,>. .. . .,. <br /> REVIEYIED YES NO REVIEY!DATE <br />