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_--0r/V3/2005 15:17 FAX 209 948n621 <br /> 11002/002 <br /> SAN JOAQM' N COUNTY <br /> ENYMON IENTAL HEALTH DEPARTMENT <br /> FFP, i) n ?Ong 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> ENVIRONMENT HLQPPA 468-3420 Fax: (209) 464-0138 Web:vriyw.co.san-joaquin,ca_us/ehd <br /> PERMIT/SEf3VICES PUBLIC RECORDS RE.LEASE APPLICATION , <br /> APPL.ICA.W: BBU,SI�NESS/AGGENCCY:,_- <br /> ADDPXSS: aW - '1 IIV W4- .�N�2z `�1 .�r,� 04 <br /> PHONE. � - �3�S' FACSIMILE_: a-Lrj`i'►S "Ofar'ax - <br /> TENTATIVE'APPbtmw ENT PATE: i,I II O Time: 12W <br /> (Please allow 10 husineAs days from date of application subminao <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ✓� DATE off' <br /> DeDa6ii nt Use Only <br /> FILE ADDRESS UNrr <br /> ,. sem, oty jmx., e-)q k. if E] - Unit 1 <br /> Z S41,9: Cy V: <br /> ,. s.M ikN O '0_9 5b Aqr- Unit 2 <br /> 4. s,MT'R D!Z 1 �F,If' <br /> 5. stet C /� !-, E, - <br /> 6. surae btl aty It <br /> 7. svc+ 4• a - f. �InitA <br /> 9. stfm 0 • Unit 5 <br /> 10. saeel <br /> -ENVIRONMENTAL HEALTH DEPARTMENT FILES )Vo <br /> VA;' -(v <br /> a UNDERGROUND TANK(UST)CL-r-ANUp SITE(LOP) ❑ HOUSING ABATEMENT IZL SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VE.NICLE <br /> i& UNDERGROUND TANK(MONrrQRtNGMEMOVAL) ❑ DOG KENNEL E1-DAIRY <br /> 0 HAzARDOUs WASTE GENERATOR ❑ CHICKEN RANCH 12-PKG TREATMENT PLANT <br /> Tf . <br /> 0 TIERED PI_RMITTEO FACILrrY ❑ MOTEUHOTEL ❑ PUMPERTRUCKTYARD/CHEM TOILETS <br /> 0 TATroOBODY PIERCING ❑ POOL/SPA 1Z LAND USE APPLICATION SITES <br /> ❑ MFOICAL WASTE FACILTiY ❑ OTHER(PLEASE SPECiFY), <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 46.4-0138 or mail to the <br /> address•indicated above_ <br /> 2. EHD will notify the applicant if any EHO 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 FHD staff may not be immediately available for review. A ne, <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 EHD staff at the expens <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to revie• <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 /> RM0 AP,PO1NTlVl Nfi <br /> AT �: :�:_:=, 'r -., {GIME <br /> _ PHONE . 1NfGIb,LS' :;; • <br /> !-gAT��Ct7N�IRME>�, ' _ _ - FAX" •• <br /> .REVIEWED YES NO REVIEW DATE' <br /> aNn dAa^aae <br />