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1-Z11/02/2004 10:04 916861Aa30 SECOR <br />r01/2004 15:10 464" ENVIPONMENTAL LTH <br />DATE RECEIVcD <br />PMrAQTJTN COUNTY <br />E LJ NvIRoNMENTAL ITEAL.TH DEPAli.'1MNT <br />304 E Weber Ave 3`' Floor Stockton, CA 95205 <br />NO V 0 2 201409) 468-3420 Fax: (209) 464-0138 Web: www.co.s=-jozquiTLcau_sJchd <br />ENVIRONMENT HEALTH <br />PUBLIC RECORDS RELEASE APPLICA,TION <br />P. <br />£Hp LOG . <br />Z0011, 05 <br />FACSIMILE: (cy i.f ) O 01 — of 4 o <br />TENTATIVE" APPOINTMENT DATE: i�--S Oy _7knp: Q 0oci -, <br />LMCZ <br />(Plea" allow 10 business days from data o(apDl'rcaGan submitla0 ru <br />Pf CHECK BOX TO EXPEME REQUEST - $93.00 FEE - REQUEST PROCESSED IN 3 BUSINESS DAYS - <br />SIGNATURE OF APPLICANT DATE 1 /-1- � <br />DaPeNnant Use ONY <br />[]/ Unit t <br />Un <br />Unit 3 <br />Wd 4 <br />Q Unit 5 <br />r• <br />-. <br />I-• <br />1 - NVIRONMENTAL HEALTH DEPARTMENT FILES �p <br />-`') CA-ASS-''/�45L <br />0 SOLID WASTE FACt iT.. <br />X( UNDERGROUND TANK (USTi CLF,,at1UP 4n'E p^OP1 <br />m <br />❑ SOLID WASTE VEHiCLE.s:-1; <br />d OTHER CLEANUP SITE ("ON -1 -OP) <br />W; UNDERGROUND TANK paONITO"GAii EMOVALi <br />FOOD <br />O DOGKENHEL <br />O DAelY <br />p 11 TREATMENT PLANT <br />W HAZARDOUS WASTE GENERATOR <br />O CHICKEN RANCH <br />O MOTEUNOrEL <br />O PUMPERTRUCrMARDNCNEMTOa-ETS <br />C) TIERED PERMfiTEb FAMITr <br />11 <br />�f tANO USE APPLICATION Srrt9 <br />O TATTOOIBdDY PIERCING110 <br />IPLFASESPfiCIFY1 <br />O MEDICAJ..WASTEFACILITYO <br />• <br />P 4NNi <br />,moi. <br />•� <br />OWNER <br />[]/ Unit t <br />Un <br />Unit 3 <br />Wd 4 <br />Q Unit 5 <br />from the <br />ist <br />bY <br />1. List up to date box se In the space <br />least one file vtype MUSTe. Select ibe s fe he 6ed f Fa�to 209 41 Oa 38 oe a hecklQg <br />the appropriate box(es). <br />address Indi 'ted abo e. appointment for review •kip be confirmed <br />2. EHD will notify the applicant H any EHD files exist to 10)p application- The files <br />approximately five business days but no tater than ten {Ell) days after receipt of <br />vjilf be held for a maximum of five business days for review. Appointments should be sch®doled <br />2ccordin9ly <br />3. A file that Is aetiveiy being worked on by EHD staff may not be immediately available for revlaw. A naw <br />application may be submitted when the file is available. <br />4. ion as released wl <br />of thele <br />iapplicant Future Fl reviews bynot returned in the same tthe same applicant may require a $93.00be reorgaii by deposit prior to review <br />¢, <br />6. <br />*TENTATIVE �¢eedates <br />leed with <br />sess day <br />pm wil be procssedthe next b in <br />Applications received after <br />TIME <br />C'6NFI9MEDAPP_-0l 'Cfs11ENTDATE — IN11N'EtLS <br />DAfE CONpIftMEI� PH17NE PAN <br />ftHVtEWFD <br />YES NO REVIEW DATE . <br />r• <br />-. <br />I-• <br />1 - NVIRONMENTAL HEALTH DEPARTMENT FILES �p <br />-`') CA-ASS-''/�45L <br />0 SOLID WASTE FACt iT.. <br />X( UNDERGROUND TANK (USTi CLF,,at1UP 4n'E p^OP1 <br />FACILITY HOUSMA8ATEMf:HT <br />❑ SOLID WASTE VEHiCLE.s:-1; <br />d OTHER CLEANUP SITE ("ON -1 -OP) <br />W; UNDERGROUND TANK paONITO"GAii EMOVALi <br />FOOD <br />O DOGKENHEL <br />O DAelY <br />p 11 TREATMENT PLANT <br />W HAZARDOUS WASTE GENERATOR <br />O CHICKEN RANCH <br />O MOTEUNOrEL <br />O PUMPERTRUCrMARDNCNEMTOa-ETS <br />C) TIERED PERMfiTEb FAMITr <br />11 <br />�f tANO USE APPLICATION Srrt9 <br />O TATTOOIBdDY PIERCING110 <br />IPLFASESPfiCIFY1 <br />O MEDICAJ..WASTEFACILITYO <br />from the <br />ist <br />bY <br />1. List up to date box se In the space <br />least one file vtype MUSTe. Select ibe s fe he 6ed f Fa�to 209 41 Oa 38 oe a hecklQg <br />the appropriate box(es). <br />address Indi 'ted abo e. appointment for review •kip be confirmed <br />2. EHD will notify the applicant H any EHD files exist to 10)p application- The files <br />approximately five business days but no tater than ten {Ell) days after receipt of <br />vjilf be held for a maximum of five business days for review. Appointments should be sch®doled <br />2ccordin9ly <br />3. A file that Is aetiveiy being worked on by EHD staff may not be immediately available for revlaw. A naw <br />application may be submitted when the file is available. <br />4. ion as released wl <br />of thele <br />iapplicant Future Fl reviews bynot returned in the same tthe same applicant may require a $93.00be reorgaii by deposit prior to review <br />¢, <br />6. <br />*TENTATIVE �¢eedates <br />leed with <br />sess day <br />pm wil be procssedthe next b in <br />Applications received after <br />TIME <br />C'6NFI9MEDAPP_-0l 'Cfs11ENTDATE — IN11N'EtLS <br />DAfE CONpIftMEI� PH17NE PAN <br />ftHVtEWFD <br />YES NO REVIEW DATE . <br />