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01/14/2005 09:46 FAX 209 9480621 002/002 <br /> �N 1 RECEIVED <br /> SANJ OAA L 111 V1\1 i <br /> CQ <br /> DEDDVDD ENV1 O"IENTAL RLALT)a DUAPUNLE1YT _ <br /> 304 E Weber Ave 3`'Floor Stockton, CA 95205 <br /> 'N 1 4( �� 468-3420 Fax: (209)464-0138 Web: �vwtiv,co.san joagUjT�.Ca-TI;/ehd <br /> ENVIRONMENT HEALTH p LIC RECORDS RELEASE A-PPLICA.'T�ION <br /> APPLICANT: <br /> SUSINESSIAGENCY.. <br /> - V31I FACSIMILE: <br /> TENTATWEt OINTMENT DATE: Time: Q 00 <br /> lease allow 10 husines,days from date of application submittal) -' <br /> CHECK t30X TO EXPEDrrE REQ EST-$33.00 FES,R>_QUEST PROCESSED 1N 3 SUSINE55 DAYS <br /> SIGNATURE OF APPLICANT DATE Al f <br /> DeRartrnent Use Only <br /> FILE ADDRESS UNIT <br /> \'LtSr ` \ <br /> s,— t c ❑ Unit 1 <br /> '6 1Dtva „ <br /> �1 4. s <br /> CRY Unit Unit 2 <br /> C;tyi• <br /> 3 <br /> i Ino -C eC <br /> 7. Streel v a �� �w*. <br /> e. sum, <br /> Cky FEB <br /> Unit 4 <br /> 9 sires a _ ❑ Unit 5 <br /> �o. same G <br /> ty 01 <br /> -ENVIRONMENTAL HEALTH DEPARTMENT HUES <br /> UNDERGROUND TANK(UST)C UP SITE(LOP) ❑ HOUSING ABATEMENT 54-SOLID WASTE FACILITY It r <br /> OTHER CLEANUP SITE(NON-LOP) d F000 FACILITY ❑ SOUO WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORI G/REMOVAL) ❑ DOG KENNEL, In-DAIRY <br /> ID HAZARDOUS WASTE GENERATOR 0 CHICK>=N RANCH I-PKG TREATMENT PLANT ' <br /> ❑ TIERED PERMITTED FACILrTY ❑ MOTEL(HOTEL ❑ PUMPER TRUCKIYARDICHVN(TOILETS <br /> ❑ TATTOOMOOY PIERCING ❑ POOL/SPA CRL LAND USE APPLICATION SMES <br /> ❑ MEDICAL WASTE FACILITY d 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(e-�). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the <br /> address.indicated above- <br /> 2. EHI)will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> approximately five bumess days but no later than ten (10) days after receipt of application. The files <br /> will be held for a maxilum 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 /> a. 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 /> F";w...,. . TIME <br /> GQNF�RMID APPOINTM-ENT�(�ATE` <br /> ATE-P <br /> • .PHONE . 'FAX'- ;�- '�ItVI?"lAL•S - =�;• <br /> REVIEWED YES No REVIEW DATE. <br />