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Ppgp'l of'1 20'19-'1'1-•1202:46:92(OMT) 18504070467 Fre m: PSWp,Woloczyn
<br /> N JOAQUIN COUNTY
<br /> EHOLOG'NUMBER
<br /> ENVIRONMENTAL HEALTH DEPARTMENT
<br /> •'.NOtl12 2013 18.68 East Hazelton Aye.nue, Stockton, CA.85.2Q5-622 "
<br /> Te1ephone:..(209)468.3420;Fax: .9138.W.e.b:v,tuw:stgo.v:org/ehd
<br /> : ' E WMRONMENTALHEALTH
<br /> PERMITlsERVICES- PUBLIC RECORDS. RELEASE APPLICATION
<br /> pe f E i entadI:auage....
<br /> : : : :APP:ktCANT . P.aycioloszyn. u... ...... ..... ssr�c m ..... .Yle,...
<br /> ARRRES..S M WW,-.1� Canxiuo Avenue jr2!�.5 .'CITYISTAI.E(zip: .SRCL111fimU)., CA 5933
<br /> PHQNE(1) 064444,654
<br /> 444-1 b54 PHONE(2) PAC811yIILE
<br /> .TENTATIVE APROINTMENT:D.A"f /I a te --/ 73 'Time
<br /> (Please allow TO busineasdays from d On^':-nplicatioh'submittal "Tentative only-must be confirmed)
<br /> . .. ..
<br /> CHEEK:$OX TQE,XP.E,DI,-TE'"t ''. �; BECK,QNCV).REQl1.E.ST�hROC!~$SED.1N 3�,BUSlNES$,DA�'S •
<br /> [ r PATE irl2�i :
<br /> 81GN.A,Ti1f�E OFAPPI.IC'�1.tVT �.. (,�s?vf s�-�: , . . .. .-
<br /> EleCtronic InfotlTlatiomi '[ List'[Map-Des.C.ription:
<br /> F.ILE.ADD.RESS EHD:USE ONLY..-. .
<br /> . ,gke¢kiE Street.N..ame: ...;'City, ...... 'r]Unit'I
<br /> 1. '
<br /> 624 . .. West Gharte> a . 5 _St. c ton. ,....
<br /> Z,
<br /> Dr . arti :Lu cr Krn Jr. Blvd. U unit 2
<br /> 3, 1:465' S. W, c6JnStreet '28 Z:2
<br /> I]Unt3
<br /> s.. 775
<br /> ::s.. . . 1601 da
<br /> . 14, 11
<br /> t
<br /> t .
<br /> 10, units
<br /> '. Apecific,Rele.Range of.Informa.tioo.Requested: From to: -
<br /> PYIRONMENTpL HE.......N':DEPARr....ENT.1 1,..
<br /> ALT
<br /> :.®UNDERGitOUNPTANK.(UST)C,LEANUP.SLTE(LQP:) E1MEDICALWA$TEFADILITY. , SO4ID WAUEFACArrY1!I:HICLE
<br /> 2)Q.THER CLEANUP.SRE(NON-LOP) 'Q.HOUSINQAbATEMENt WASTE TIRE _
<br /> �UNDERCROiIND TANK:MONRD Ip1GIREMOVAL) [':FOOD FACILRY ' I,�DAIRY' ~ .
<br /> .. 4.. .. ., a....:. . ... .. ;
<br /> . ®A80VEGROtINRT,ANK : _ (].CHICKENRANCHID�.OISENNEI,. '. :[WASTEWgTER:TREAT.MENTPLAM '
<br /> ®H[iZARD.QUS WAST;E(iIAZARDQUS.MATER(AL$ ` . . " [MOTWHATEL '. L PUMPER TRULKIYARDICHENIICAL TOILETS. .
<br /> ®TIEREgFi=.RM1TTEq FACIL.ffY,. OPOOLISPA. �I❑—I LAND;US$,ApPLICA414N SITE5,,.,,
<br /> [TATSOOIBDDYPIERCING ®COMPLAINTIRESPONSERECORgS DOTHER.(KEASESPECIFY)
<br /> .®WELC AND$EPTIC:PERMIT RECOR�$'ARE AYPJLABLE FOR_REYIEW MONDAY-FRIOAY':S GOO AM 5;00PM(ExC4UOING HOUE)AY.S)
<br /> ^1.. List up to ten addresses in the space above. Select the.type(s)of files from the:listabove by checking theappropriate
<br /> `:box(es), At least gne:file type.MUST be:selected.:Fax to(2091464-0138 or"mail to the address indicated above. Address. ._ '
<br /> 'tangos will notbe.accepted-for additional assistance with file addresses,contact the.EHD. Applications'receiyed after ...
<br /> 3:0Q pm will be.process6d the.next bupiness.civ.
<br /> 2: 'The.EHD will notify the appiicantif any EHD files exist An appointment forteview will he confirmed.approximately ten(10)
<br /> days after receipt:ofapplication. The.fileswii(beheld.fora;maximuitnffive:b.usiaessdaYsfor..rexiew..APp.ointments
<br /> 'should.be:sched.Pled,accordmgly..
<br /> 3, A fife that is actively being.worked on by)",HRstaff may not:6eimmediatelyavailable for.review, Anew application in bi
<br /> submitted When the:tile.is.available,. '
<br /> A_ Any filenot returned.in.the same condition as re,leased willl.be reorga n ized.by'EH0staff at the expense of the appiica nt
<br /> Future file reviews.by the same applicant may require A$125 deposit'prior to review- *^ SbY6b AREA, '6HO osi50
<br /> sa
<br /> ❑ ReL6ords prpyided by Staff-PFR Complete. Staff Name:
<br /> -EHD 48-06
<br /> Rece. ived Time Nov. 11, 9013 C) :4-/PM h. 4497
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