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CYID LOG NUMDC`1 <br /> SAN JOAQUIN COU1V'CY <br /> ENVIRONMENTAL kIEALTII DEPARTMENT <br /> NUV Z 0 2001`�g 304 E Weber Ave 311 Floor Stockton, n j 95205 &fo <br /> ENVIRONMENT HEA 468-3420 Fax: (209) 4G4 0138 Web: www.co.san joaquin.ca. s . <br /> va <br /> PERMIT/SERVICC�EIS,^ (� PUBLIC RIECORDS RFLEASI,��f APPLICATION <br /> APPLICANT: nI�V N-tit GG-a7 _ BUSINESSIAGENCY: /V�) D, /1"rAA,4 <br /> ADDRESS: aD ►tt�.vS a-P (Nay X211_-G4o f <br /> PHONE: N-1 - _tv\ FACSIMILE:, ✓W 1 D�-2`Z <br /> TENTATIVE"APPOINTMENT DATE:•�,1 tl 7pTime: <br /> (Please allow 10 business days from date Of application submittal) <br /> CHECK BOX 70 EXPEDITE REQUEST-$93.00 FEOE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �—f DATES 0 <br /> Denartment Use Only <br /> FILE ADDRESS UNIT <br /> t. street •383(e hl. .f .�j+VV_1 C11 Unit 1 <br /> 2. street 3` ,3 I 1tn'� •` CI <br /> 7Sireal 3937 <br /> ' r"r• CII Unit 2 <br /> a. Street -^ �I U e Q•'r'� , V,` CII a O A` <br /> s. svee 3: r AA k cl Unit 3 \1i <br /> e, street 0 9 ' 1ST vim'._� GI <br /> ]. Street 1 J-2- IV, PJ a,-y0at <br /> 8. Street 39-2- QN•J I rN�—...^—y-�'� <br /> 9. street 39f(-( . �" HACCtlX __ en Unit5 - <br /> to. slant VLJ� CI i <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ; <br /> UNDERGROUND TANK(usT) UP SITE(LOP) <br /> ❑ HOUSING ABATEMENT 0 SOLI <br /> OTHER CLEANUP SITE(NON-LOP) I:) FOOD FACILITY ❑ SOLID WASTE V CLE <br /> UNDERGROUND TANK(MONrrORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ���LLLL HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL Cl PUMPER TRUCKA(ARDICHEM TOILETS <br /> TIERED PERMITTED <br /> ODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITFS <br /> 0 MEDICAL WASTE FACILITY ❑ 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)464-0138or 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 EHD 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> END 48-02a06 <br /> erenaea <br />