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Oct: ..14 2004 1 ; 18PM „--. Fc rn'e;:I- At L�ui <br /> 10L 1; 1X084 14 3; 46401313 ENVIRONMENTAL HEALTH PAGE aL <br /> D T REC D SANJt)AQUIN COUNTY <br /> NvjRoNMENTAL Thi DEPARTMENT <br /> OCT 1 4 2004 304,E Weber Ave P Floor Stockton,CA.96206 <br /> i{ Q9 68-3420 'AX: (209)464-0138 Wets:Www.co.San-joaquin.ca-us/chd <br /> 207 ,So" <br /> PUBLIC R19CO"S RMEASE APPLICATION <br /> DI �5 <br /> ADDRESS; <br /> Ht3tdE: <br /> TENTATIVE'APPOINTMENT CRATE. Time: <br /> (I,1609t allow I0 sac{ as days from dale cif application submittal) <br /> CH £ TO EXPEDITE REQUEST FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> ®ATS <br /> SIGNATURE OF APPLICANT OepaMwnt U04 Gn1Y <br /> I <br /> • UNIT <br /> FILE ADDRESS <br /> ® unit I <br /> }, s#eei <br /> Sip C4 <br /> a. si p Unit 2 <br />`s s, SOW <br /> C i d <br /> I e. 8"j41 Unit 4 <br /> �. AIteei c <br /> 4, �reei <br /> ENVIRONMENTAL K-ALTtf DEPARTMENT FILIE <br /> >a tltyuslNQ ABATEMENT [� SOLID WASTE FACILITY <br /> NOERGROUND TANK LUST}OLEANUP SITE{LGf) Ci Ft�d7S�FAC) C3 STOLID WASTE V£H1CLE <br /> t3THER CLEANUP'SIT£(F 0"4-0p) C3 000 KENNEL � pA3RY <br /> C} U(�pE�GROUIVt7TANFL(MDPiITORINGtFt£rADVAi} CI CHICKEN CH M PIKG ATMEr T <br /> Gi >N i?GtJ3 WASTE UI:4 16R MOfitiLltit?1EL ® pUMPER't{'�13CK A1=WiCHFM TOILETS <br /> 0 C; <br /> C'I TiER£t{1'ERhIITTED FACILITY O LARIO USE APPLICATION 315 <br /> p PA <br /> TA,T>"OOMDDY PIERCING 0 OTHER(PLEASE SPECIFY} <br />! Cl MEDICALWASTE FACILITY <br /> E s of files from the list above by, hacil" <br /> C List yap la ten atfdreeee 11�the space above. the { } <br /> the appropriate b�${es}. �,t lest one file type lit} fee se{cored, ax{ 2b �b4-D 13r9 or rnaii o the <br /> addraSS Indicated Abt�ti@. pperltttl*t tlttor r low Will ►nftprnaai <br /> neW utlll r"►DNfy the applicant if any 0*10 file$exist, �Gelptapplication. The fit" <br /> 2. epproxirttetely f1rrE bus'"ass days> tet r1 later than ten(iC)days often rG ntas sho+ald scheduled <br /> will be held for a e9 Oximurn Of flv+2 business days for revla�. Appo' <br /> e for review. Anew <br /> accordingly. May <br /> 3. A fila that iib acti�rjly being worked on <br /> b fire is available. <br /> not Ibe Immediately dvailabfstaff at the n� <br /> epplioatIon may be p In the <br /> whenalit prior a revteo <br /> d. y file dart ret>lt�ecf in t}te earns e�hdltthe cam released licant M&y require a$93,00 dap <br /> of the applicant, �Iatu{4 File IsvieSnts + �tlth� w. <br /> tlo staff. <br /> *Z pP�T�.TI aPp�Intln+erlt date nutlet b13+coraroce d tft�next businaea day. <br /> �. Appitcatiorls received after .+Db pm wt{t bar p <br /> Tltvit <br /> CONFIM �APPC Iii Tf>AF�IT SAT PHOPiE : F NIT` $ <br /> DATE i;ON1 IRMED REVIEW DATE <br /> E <br /> R @ <br /> aB^9X+Q6B, <br /> ' 84W <br />