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11/17/2000 14:e9 916-766--166 LFR pi 1 01 <br /> MORROSAN JIDA.QUIN COT-7-Na'y E H D .0 G N J <br /> E <br /> NOV 1 7 2006 REALIM DKP�Alk INNT <br /> 304 Fast Weber Avemue, 3'd Floor, Stockton,L_4.95202-2708 q <br /> Tele#hone:(200)463-3420 Fax: (209)464-0138 Web: v,.rwvi.sjgov.org,'e'1d <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBT,jCRY-CORDS RELEASE APPLICATION <br /> XPFUGANT: SeC>f SIAGENCY- <br /> ADDRESS; <br /> PHONE(1); PHONE 7 <br /> TENTATIVE*AFOGW7 I ME ENTD-ATE: <br /> GHE-K B'OX TOEXPEDNTE FE,(AUFST-!"5.0�0!FEE(GASH OF.CHECE.ONLY R.L:rQFEST,-'R01M4SaV.N 3 BUSINESS 01, <br /> DATE <br /> SIGNATURE OWAPPLICANT <br /> Electronic Information; Ust 0 Mzp V-sszriptlon: <br /> M�LEADDRE!��:- ONLY <br /> Street 1q, City <br /> "awk Name Un?: <br /> ATZ <br /> 2. 1 ---runit 2 <br /> 3. 1 <br /> 1 ---/ .1 <br /> - 1 <br /> , "-Unit <br /> 4 <br /> r <br /> I.Ut 4 <br /> Specific Vate Rar,90 of lnforfri---tlor Requested'Fron <br /> EN IRRONME-N.TAL HEALTH DEFkART44TENT FILE$ <br /> TZ5_1UNDERGROUND TANK(UST)CLEANUF$ITEE IXOR' M HOUFING ABATWNIEW P-'rSOLIO WrA.3-E FAC!'J-,Y1VIEH1CLE <br /> 60THER CCEA NUP SITE(NO--iLOP -M Foop FA,:aLrTY El WASTE-TIFIE <br /> -UNDERGROUND TANK(MON170141MVREMOVAL) 7:1 DOG KENNEL M DARY <br /> &HA7ARDOU1 WASTE GENERATOR ':n.CHICKEN RANCH F41VASTEWATEER TR9ATV4ENT7'.A-,N' <br /> 191 TEERFOPERMITTED FACILMY M,NoTELJHL)TEi- JKPIAVER TRUQ';fY&RQ,Q'1'!— <br /> J TATTOICVBODY PIERCING M POOL/SPA -0,1-AND U,5E APPLICATION SITES <br /> -MEDICAL WASTE FA CILrIY D 07MER(PLFASE <br /> WELL AND SEFITIQPEOMIT RECORDS AFE A`Ai. FOR FtEviEw - MoNoAY-FRjvPY 8,00 AM-6:00PM - Exctumr.HOLIDAY S. <br /> 1. List Lip to ten addresses 10 the spaceiabovs. Serect the type(s)w Fees from the list above by cher Win�jhe apr ropri ta <br /> box(es). At haat one Me f-ype MUST be selectee Fax to(209)4C,4-PA38 Rrmail to "e -cftknewin—d1cated above- Ad frees <br /> ranges will not be ecceptdd-ftradditiopal with file Lddresq-zas.rbritac-t the-EH D.Application*received ifter <br /> 2�-00 0"n V'1111 he FITracessej th:a iiext business day, <br /> 2. The EHD will notfTy the appffca-,it if easy EHD filiss exist. An appoino,-ier4t.ftrl rRview will be -.00fliined approximate';: :en(40) <br /> lays after receipt of appii�aticn. The Oez-velii ba,held for a mammu rn of five business days for review. ArPoi t-> <br /> should be scheduled accOrdingly. <br /> 3. A file that is actively being we rkad on by F-HD staff inay not be inirrediateiv available for Anew�ppllc;Ifiory nay be <br /> submitted whei t1??Me is avaliable. <br /> 4. Any fl;e not returned in t'6same condition as rei(aaaed will be reorjanizsJ.by FHD st-niffat the expense of the apph(ant <br /> : 0 <br /> Futtire file mviews bma y theisame applicant ��rinquire deposit prior to review. <br /> EHD USE ONLY <br /> =HQ-111z-rG 8113,12we <br />