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0o2/ooz <br /> ---1.3W15/2005 16.55 FAX • - '- " " <br /> OATS R(EECENIZO SAN .I OAQw COUNTY <br /> FNV 0 NMENTALHEALTRDE1'A1tTMEiVT <br /> 304 E Weber'kve 3'd Floor Stockton, CA 9,5205 d <br /> uiamusleb <br /> NOV 1 6 ! h) 468-3420 Fax: (209) 464-0139 Web: wWw.c0•SSD`J q <br /> ENVIRONMENT HEALTH PTJBLXC RECORDS RELEASE AYFLICAnbN <br /> PERMITIS <br /> nay, ,�_ F.��tJ� --gUSWESSTAGENCY: <br /> APPLICANT: TL� <br /> AnoREss: <br /> Z-1 <br /> FACSIMILE: ZO�I <br /> PHONE: `- Time: <br /> TENTATfVE'APPo1NTMENT DATE: <br /> (Plea,,allow 10 business days from data of aPPliqdan sut,niffatJ t1_ <br /> ❑ CHECK BOX 70 p(PFy(TE REOUSST/$93.000 FFIEERERUES�T PROCESSED IN 0®OSMESS DA"DATE /0 <br /> SIGNATURE OF APPLICANT 1�/���" -T` De°a`r`ientUse 01* <br /> UNI <br /> FILE ADDRESS Q Unit 1 <br /> �oaK3 z E F. X45 ! Unite <br /> Unita <br /> C, o Al <br /> L ° F u <br /> . I <br /> F [3 Unit s <br /> tfo�a� ` •. � <br /> ' .I..,t.J� <br /> ENVIRONMENTAL 1'IEALTH DEPARTMENT FILES <br /> F4,•souo WASTE FACILITY <br /> CLEANUP SITE(LOPI ❑ NOUSiNG A9ATEMENT ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK JUST) ❑ fDOD FACILITY EL DAIRY <br /> OTHER CLEANUP SITE(NON-Lopt t7 DOG KENNEL <br /> ONITORINGTREMOVAL) ❑ CHICKEN RAfiCH �-PKG TREATMENT PLANT <br /> a UNDERGROUND TANK Pa ❑ PUMPERTRUCKJYARDJCHEI1TOILETS <br /> in HpZARDOiis WASTE GENERATOR ❑ MOTELMOTEL M LAND USE APPLICATION SMS <br /> ❑ TIERED PERMITTED FACRITY ❑ POGUSPA <br /> _ ❑ TATT0pr90DY PIERCING p OTM5-:R(PLEASE SPECIE'() <br /> ❑ MEDICAL WASTE FACILITY ya by checking <br /> Ust up to ten addresses in the space above. Select the type(s) of fifes from the list aho_ <br /> 1, a MUST be selected. Fax to 209 464.0138 or mail to the <br /> the appropriate ed above. <br /> box(es)- At least one file type ointment for review will be confirmed <br /> address.indicated aha -ant if any EHD riles exist An app application. The riles <br /> 2. EHD will notify the app y days after receipt of app <br /> approximate( five business day! but n°later than ten (10j y <br /> will be held for a maximum of five business days For review• Appointments should he scheduled <br /> accordingly. available for reYiew• Anew <br /> g A file that is actively being worked one EHD staff may not be immediately <br /> application may be submitted when the file Is available• require a$93.00yE deposit poor to review. <br /> 4 Any file not returned in the same condition as released <br /> anit may eq ire a EHD staff p the expense <br /> of the applicant Future file reviews by the same app <br /> 5 'TENTATNE appointment dates must be confirmed with EHD staff. <br /> received after 3:00 pm wilt be processed the next business day. <br /> g Applications <br /> ' .P�INTM�NT7S'AYE=ir '. -,•.S. IME <br /> '�`.•._,h , Y • <br /> PHONE <br /> . . . .... .:. <br /> FAX''',_.'' ",. : .. . ..- <br /> NEI ETa <br /> ?pAT;e..C4. RFA REVIEIV DATE' <br /> REVIEWED <br /> YES NO <br />