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9 FAX rtjg G 0 2 <br /> SAJ'i JOAQUIN COUNTY E1472 LOG NIAAMER <br /> no ED <br /> wcmv iii)X-1,0 HEALTH DEPARTMENT OZ,71 <br /> SEP 2 9X006 /7— <br /> 3-04 1"'a!-;t Weber Avenue, 3"d Floor, Stockton,CA 95202-2708 <br /> -1, <br /> elenhone: 00/9)468-3420 Fax. (209)464-01318 Web:ww�V.sjgov.org/eM <br /> ENVIRONMENT HEALTH <br /> q PUBLIC ;.ECOIDS RELEASE APPLICATION <br /> PEP'MITW. <br /> C' BUSINESSIAGENCY <br /> : <br /> G V, JA <br /> ( <br /> P V0 NE f I �f?fllz PHONE(2): X) J17 713(, FACSINULE: (20,j 2372 71 <br /> DATE: Tmfe: <br /> 'P:eP,-,a 10 busi'ne_s d?.,ys ftm datq of application submittal-*Tenfathe only-must be cunfinrmd) <br /> NE�i%, <br /> FsO K T 0 F-X F Ov i T E F.E 5 -7�i f-,T- ECK ONLY)-REQUEST PROCESSED M 3 BUSH, i DA,'�: <br /> V3,00 FEE(C <br /> DATE <br /> SIGNATURE CDFJWPUC�ANT <br /> Di1,TF6;3UT1jQN ji Un tz4m. ap-.,i <br /> un, f 0 Unit 2 17 Unit 3 13Unit4 01.11nitS L "t 6 0 Other(e�ectran:c/Ns <br /> FEE-ADDRESS <br /> EHD USE ON f <br /> p <br /> SRapt biome city <br /> lo, <br /> mc <br /> ""I TtAr'-V ........ <br /> 4r <br /> "j <br /> ...... .-ICA <br /> C q!Z 5 L <br /> j —.1 <br /> )'Q <br /> I i-I 5T <br /> Spectflc Eloto of informa-don'Requesteed:FI Om <br /> E-N-1,11RONMENTAL HEALTH DEPART <br /> ME� OF D WASTE FACIL17 Y/VFH LE <br /> e; L HousiNG ABATEMEN <br /> HE, FOOD FAcILrrY 4=WASTE <br /> 'nPE <br /> JDERGROUN.-UNK(lTi0NIT0FJT--.o1REh-1.QVAQ 01 DOG KENNEL <br /> IN M'DAIRY <br /> ' PPF-APDOUS'A"ASTE GENERATOR CHICKEN RANCH. MWAS TEWATERTREATMENT PLANT <br /> KND PEMP <br /> RTTED FACII'IT Y MOTELIHOTEL 0 PuvPER TRU-KIYARDX�f EM TOR.ETS <br /> ­Uz-F <br /> 0 FOOUSPA M LAND USE APPLICATION SITES <br /> -,L 1NASTE FAcUTY <br /> 0 OTHER(PLEASE SPECIFY)___ <br /> WELL AND SEF-79C PERMIT RECORDS ARE AVAILABLE FOR REVIEW w MONDAY-FRIDAY B.-00 A1,1-5:€0PM - F--XCI.U;).NG Hol-MA!'3, <br /> L'.!-,' pt'. t�� njdrem —In the space above. Select the type(s)of flies frornthe fist above by checking file <br /> appmpriate biax(es), At least one file type MUST be selected. Fax to(2U9 464-0138 or mail to the address <br /> Indicated above. Address ranges will not be accepted-for additional assistance with file addresses,contact <br /> the EHDAp,-O;cations�recewed Ffter 3.00 pm will be processed the next business dad, <br /> e E�D wg!a <br /> �nratify theapplicant ff any EHD files exist. An appointment for revieww'11 be confirmer., <br /> ly ten 'fit day" �'Rer receipt of application. The files will be held for a maximum-o?fife b?isfness <br /> 4 o-it =rte heduled o In, <br /> sihoijkibesc acc rd" a <br /> <; +;;dve-,y b-,a'ng ovorked on by EHD staff may not be Immediately avaHable for revievi. A new, <br /> pi',,,atlen. may be sulamitted when the file is available. <br /> 4. r.nv f0e not n�tunqed in the sane condition as released will be reorganized by EHD staff at the expense of the <br /> a Future fiie re-view-s t�y the same applicant may require a$9100 deposit prior to review. <br />