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X1/14/2001 17:36 20934228 NEILL AMDER50N ENVIRO PAGE 02/0 <br /> AERN ED 1 <br /> E11D LOG NU :R <br /> SAN JOAQU� COUNTY <br /> ]ENVIRONXEN'Ti'.AL�1✓� TH DEPARTMEN�:l <br /> :I <br /> 304 E Weber Ave Yd Flooi - <br /> rStockton, CA 95205 E 0 <br /> PyVInO�ll clr�T 1� X463-3420 Fax: (209)464-0138 Web. www.co.san 53 <br /> joaquin.ca.us/chd <br /> PERMIT/SER ES <br /> t <br /> PUBLIC RECORDS REI. ASE A PPLICA,TIO��N' <br /> APPLICANT: Ca-c-Gy A�BUSINESSIAGENCY: r� Opt-`_ (} . AIAJ' .�1.!«G�'- F A-sSa c = ' <br /> ADDRESS: I' <br /> �ff 2 NAA:?: f&^k �V ' r .. <br /> PHONE: 3>_.0 -FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: � ��_ Time: <br /> (Please allow 90 business days frorn date of application submittal) 1 <br /> CHECK BOX TO EXPEDITE REQUEST-$V.00 I`:E9-REQUEST PRO"55ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Oniv <br /> FILE ADDRESS UNIT -` <br /> t. Street tis S• es VL b A-vwe . city <br /> 7,040 W . W ou,-, i S ca <br /> - L7 Unit 1 <br /> 1 <br /> 2. Of-ill - <br /> I <br /> 3. stied cl!y Unit 2 <br /> A Street <br /> 5 Street CI <br /> 6. Strry _ Unit 3 <br /> r. street (Unit 4 <br /> a, Street G <br /> a- street Cit [] Unit 5 <br /> to. Street C I <br /> I <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING AGpTEMENT' 0 SOLID WASTE FAGLriY <br /> 4A OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILItY M SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNELI ❑ DAIRY <br /> IAC HAZAADOUS WASTE GENERATOR d CHICKEN RAgCH ❑ PKG TREATMENT PLANT I <br /> T TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL Q PUMPER TRUCKIYARDIGHEM TOILET ; <br /> C3 TATTOOIBODY PIERCING b POOUSPA M LAND USE APPLICATION SITES <br /> ❑ MEDICAL.WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Sete t the typo(s) of files from' <br /> the list above by check; <br /> the appropriate box(es). At(east one file type MU T be selected. Fax to(209)464-0138 or„mail to th <br /> address indicated above. C <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 file <br /> will be held fora 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 n <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 akpen <br /> of the applicant. Future file reviews by the saute applicant may require a$93.00 deposit prior to revil <br /> S. 'TENTATIVE appointment dates must be confirms with E"D staff, <br /> 6. Applications received after 3:00 pm will be proces ed the next business day. <br /> CONFIRMED APPOINTMENT DATE _ . -_T TIME j <br /> DATE CONFIRMED PHONL FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> MIMI <br /> 1 <br />