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r r <br /> 10/26/2009 08:44 209-668-2598 FADE 01/01 <br /> SAN JOAQM COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> OU 2 6 2009 304 E Weber Ave 3`'Moor Stockton,CA 95205 <br /> S��l 7 /t T(2J09)468-3420 Fax: (209),464-0138 Web:V,(WW.co.san-joaqu.in.ca.uS/e <br /> ENV!Ru-'NPi1t':i i HFALk 11 <br /> —r- <br /> PERM M'SER I0E5 PUBLIC RECORDS RELEASE APkLICATYON <br /> .APPLICANT:�AI..G'11 A/ASZ BUSINFSSIAGENCY: S/V!E <br /> ADDRESS: Q . 4 L 06 I <br /> PHONE: t p 3 FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: <br /> (Please allow 110 business days from dat0 of application Submittal) <br /> CHECK BOX TO EXPEDITE REQUEST 93.00 FE REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE _ 169-Z <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> �. sued gA CRY <br /> M C <br /> z. street y� <br /> _4 <br /> 4, &veal <br /> 5. Sbve <br /> 1111; e. Street UY -❑ Ui►il 3 ," <br /> I 7. Streel my <br /> ❑ Unit 4 <br /> a. ease, <br /> Ply <br /> 9. Shoot oty <br /> ❑ Unit 5 <br /> i 1a, Slroei � <br /> ENVIRONMENTAL HEALTH DEPARTMENT FIDES <br /> 13 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) r7 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) 173 FOOD FACILITY d SOLID WASTE VEHICLE <br /> 13 UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNE=L a DAIRY <br /> EI HAZARDOUS WASTE GENERATOR CI CHICKEN RANCH In PKG TREATMENT PLANT <br /> G TIERED PERMITTED FACILITY d MOTEE_HOTEL O PUMPER TRUCKIYARDICHEfA TOILETS <br /> El TATTOOBODY PIERCING 0 POOLISPA LAND USE APPLICATION SITES <br /> d MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space.above. Select the type(s)of files from tate list aboye by chocking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to_(209]..454-,513.8 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application. The files <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 same condition as released will be reorganized by EHA staff at the eXpense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6% Applications received after 3:00 pm will be processed the next business day, <br /> GpHIaMEb aoirnNr PATI: ririniv <br /> ',DATA-CONFIRMS pHOhi : FAX' INI IAL <br /> .. <br /> AEVIEWEI) NO REVIEW BATE: <br /> EHD O.88$-604 <br /> !!97.1063 ' <br />