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1/2004 13:53 FAX 1 209'e-14 7727 STOCKTON <br />HMID <br />2/2b/ 00Ad <br />4643 ��� (� EFNIRONMENTA�=ALTH <br />V� IJ�L�J SAN JOAQUM COUNTY <br />ENVW0NNMNTAL HEALTH DEPARTMENT <br />MAR 0 1 2�2004 MI N$ �6-3420 304 E Weber Ave 3' Floor Stockton, CA 95205 <br />ENVIR0NMENTT-iFax: (209) 464-0138 Web.. y, , .M.,,n J in.ca.us/chd <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPIWATION <br />APPLICANT: , -r <br />ADDRESS:3g10 �,tl <br />Z002/009 <br />PAGE 01 <br />CnV Lw itV4vw61 <br />BUSWESSlAL3ENCY: G1laiiacG- +� ri A ssDc- <br />PHONE <br />Z Z FACSIMILE: T O ct 1-31— -4 -7 2 _ <br />TENTATIVE" APPOINTMENT DATE: <br />Tirt+e: <br />Alyse &Now 10 busk -ss days fivers date of epplio4on submitlaQ <br />CHECfC BOX TO EXPEDITE BEQUEST - <br />n V.DO FEE fXPUgMT PROCWSED IN 7 6USNESS DAYS <br />SIGNATURE OF APPLICANT <br />A <br />DATE 3-/-0 L _ <br />DeparbrwK Use only <br />UNIT <br />[] Unit i <br />Z � <br />❑ Unit <br />a 3 �UrA 3 ) <br />Unit 4 <br />Urtlt 5 <br />ENVIRONMENTAL HEALTH DEPARTMENT FQ.ES ,; P 0 111 <br />S 4-3 <br />UNDERGROUND TANK (UST)CLEANUP SITE (LOP) 0 HOUSING ABATEMENT O SOLID WAS rE FAW ` <br />Bi OTHER CLEANUP SiTE (NONA.OP) O FOOD FACtlMY 0 SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MOITOR'NOMEMOVAL,) O DOG KENNEL 0 DAiRY <br />0 WARDOUS WAST!_ aENERATOR V CtUCKEN RMCH 0 PKG TREATMENT' PLANT <br />0 0 TIMM PERMiTiED FAC11MY it IAOTELMOTEL 0 PUMPER iRUCKIYARDOOMM TOi XTS <br />�eD v� FWRC TY V POOLISPA 0 LAND USE APPLICATION SITES <br />O OTHER (pi rASE Sa�dFYl _ <br />1 • List up to ten addresses in the space above. !Select the typa(s) of flies from the tlst above Py cbecWng <br />the apprapdate box(eS). At least one file type MUST be selected. Fax to t20914 fiHIS8 or mail to the <br />address indicated above. <br />2. EHD will notify the apprm int if any EHD files exist. An appointment for review will be confirmed <br />approximately five business days but na later than ten (10) days after receipt of alppl"Ic2Mon. The fates <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. A new <br />application may be submitted when the file is available. <br />4. Any file not returned in the sante condition as released will be reorganized by EHD staff at the expense <br />6. of the applicant. Future file reviews by the same applicant may require a $93 <br />*TENTATIVE appointment dates must be confirmed with EHD staff. <br />8. Application's received after Sb0 pm will be processed the next business day. %2-9, <br />��n!�;t�M, _ �AP;�?btNTl4A1_N'�`4A � �•:;.y:-,... - .c,;:::•' , �:. :.:: � - �:=.. <br />��.. M-�(' � 1:'; �': ''.1' .f '��� rir.]1���� .� �:i: �y1n.::::' � •w�� �. -.t.r l': <br />'iSAT�CC,�N1tt•RIY��p : .. ti�,� .. .: ..,.:.:', • �::.. <".;r- <br />(tl:Vi>✓WED. � - � :-.� 'YES � ' .'ND .. ' . ,` REVIEW DAT'=' ;j'� ��..� .. - ... _ ... .. . <br />fafU b�iAOi <br />tlV200] <br />