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EHD LOG NUMBERIlly 11 I LJ SAN JOAQUIN COUNTY(—; <br /> ENVIRONMENTAL HEALTH DuART1Vlv)>rN`Ti' <br /> NOV ,) 2 304 E Weber Ave 3"'Floor Stockton, CA 95205 <br /> �09)468-3420 Fax: (209)464-0138 Web: www.co,san-joaquin.ca.us/ehid <br /> ENVIRONMENT HEALTH Z07qp <br /> PERMIT/SERVICES PUBLIC RECORDS REEEA.SE APPLICATION <br /> APPLICANT:QQ rr��IjaO S 8V$IN6SSlAGENCY: s� <br /> ADDRESS: qoz. ryY�.r21[_3 1L1 E p �1 <br /> PHONE: !-J FACSIMILE: cI-P .' G2 �_ <br /> TENTATIVE*APPOINTMENT DATE: d- r ] Time: <br /> (Please allow 10 business clays from date of application subrrlittal) <br /> CHECK BOX TO PXPEDITE REQUEST-$93.00 FEE--REQUEST PRCCVSSED IN 3 BUSINESS DAYS r <br /> SIGNATURE OF APPLICANT ��� DATE t1I Z-r—/0 <br /> DaDadment Use only <br /> FILE ADDRESS UNIT <br /> ., <br /> 2. Street ._51-10� V& 01r c���1 _^��15� El unit 1 <br /> V <br /> p TJ <br /> a, Slreet {V AC A-VR- CIi C� lfl <br /> 'Unit 2 <br /> 4. scree: <br /> s. steel 7 DIL- Unit 3 <br /> s. sly, 11 L� ?t i� a,�� ✓1 ��. �ti� <br /> 7. smat Unit 4 <br /> 9. steel CRY Unit 5 <br /> ,a. sires, a <br /> �/ <br /> ENVIRONMENTAL HEALTH (DEPARTMENT FILES <br /> Gz UNDP,RGROUND TANK(UST)CLEANUP SITE(LOP) C1 HOUSING ABATEMENT 13 SOLID WASTE FACILITY <br /> LMI OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> I�=EER'E"r) <br /> (UNDGROUND TANK(MONrrORINGInEMDVAL) 0 DOG KENNEL 0 DAIRY <br /> DOUS WASTE GENERATOR 0 CHICKEN RANCH ID PKG TREATMENT PL-ANY <br /> PERMrI`TED FACILITY C3 MOTgLIHbTHL Irl PUMPERTRUCKIYARo1CHEM TOILE" <br /> ❑ TATTOOWDY PIERCING O POOLISPA 0 LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY 0 OTHER(PLE=ASE SPE=CIFY) <br /> 1. List Up to ten addresses in the space above. Selact the type(s) of files from the list'aboye by checking <br /> the appropriate bOX(es). At least one fife type MUST be selected. Fax to 209 464-0138 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 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. *TENTATIVI;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 /> YNb tdA2-04C ' <br /> Bf9�00� <br />