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11/10/2000 12:42 209-579 '25 MODESTO ATC _, PAGE 02 <br />U 579-2 5 P. N� <br />FROM <br />SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />NOV 10 ZOOO ENVIRONMENTALON <br />AST W SER AV NUEI, THIRDTH FLOOR <br />ENVIRONMENT HEALTH STOCKTON CA 93202 <br />PERMIT/SEER It (209) 468-3420 <br />�5 <br />PUBLIC RECORDS RELEASE <br />/APPLICATION <br />I _ <br />A"LAViT '�.J/'t�Gr! Q,v� 1'1'1 9USINESS/AGENGY —V �'Idw ^' <br />A_.5V <br />aa.(I1� �l ui�CY53 <br />AOb�b9 <br />rE }, �FACSIMILE <br />iipj ��1—ty <br />IN TT IVE APPOtNTh1EN7 GATEQF W ° K TIME <br />-'�% (pleasg glue 7 to 10 business days from date of BPPllcatipn $UbmiUq <br />u <br />is/ „CHECK BOX TO "pE01TE REQUEST - $78,00 FE -REQUEST OCESSE0 IN a BUSINESS DAY$ <br />T�, �-- I l ctO l0� <br />SIGNATURE OF APPLICANT V CV, CATE � <br />FILH ADDRESS <br />._ _ .it _ n •..>, _ r�..-�i4 Ci-�� ILtb�n JJ �i, r,21.> l"VLI, <br />E�7 <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGRW ND TANK IUST) CLEANUP SITE (:.OP) G HOUSING ABATEMENT ❑SOLID WASTE PACILITY <br />0 SOLID WASTE VEHICLE <br />O DAIRY <br />OTHER CLEANUP SITE {NON -LOP} ❑FOOD FACILITY <br />G UNDERGROUND TANK (MONITORW6lREMOVAL) d DOG KENNEL <br />❑ HAZARDOUS WASTE GENERATOR 13 CHICKEN <br />u <br />1, List up to ten addresses In the space above. Select <br />RANCH <br />l7 <br />PKG TREATMENT PLANT <br />0 <br />TIER@OPERMITTEDFACILITY <br />n <br />MOTIFUNOTEL <br />❑ <br />PUMPER TRUCKIYARDICHEM TOILE TS <br />C3 <br />TATTOaapOY PEIRCING <br />0 <br />POWSPA <br />O <br />LAND USE APPLICATION SITES - <br />0 <br />MEDICAL WASTE FACILITY <br />O <br />PUBLIC WATER SYSTEM <br />0 <br />OTHER (PLEASE SPECIFY ABOVE) <br />the types) of !ilea from the list above by checking <br />tho appropriab box(ea). At least one ills ryptl MUST be eelecled. Fax to ($fj,9) 4G4.0138 or mall to the <br />address Indicatod above, <br />2. EHD will notify the applicant It any EHD tiles exist. An appointment for review will be confirmed <br />approximately five business days but no later than tan (10) days Atter receipt of application. The files <br />will be hold for a maximum of five business days for review. Appointments should be scheduled <br />accordingly. <br />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 same condition as released will be re0rpanized by EHD staff at the expa.nse <br />of the applicant. Future file reviews by the same applicant may require a $7800 deposit prior to re <br />staff. <br />view. <br />5. "TENTATIVE appointment dates must be confirmed with EHD <br />6, Applications received after 3;00 pm will be processed the next business day, <br />INITIALS <br />E <br />I <br />CONFIRMED APPOINTMENT OATS TIME <br />DATE CONFIRMED PHONE FAX <br />REVIEWED YES NO REVIEW DAT <br /><h Oa atcirop <br />TOTAL P. 02 <br />