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03/13/2006 15:09 FAX IA 002/002 <br /> �eRLCE1VED �� �� cn......,•.,.,.,..-. <br /> Is���FRED SANJoaQUil�l COUNTY \ <br /> k NVIRONNIENTAL H.EA.LTu DEP,RCrrrFNT <br /> 0MAR 3 2 304 E Weber Ave 3b Floor Stockton,CA 95205 <br /> �) 468-3420 Fax: (209) 464-0138 Web: -vvw-.Y.co.san-joaquin.ca.u-,/chd . <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RE, CORDS RE LL,ASL APPLICATION <br /> APPLICANT: tekotly) BUSINESSIAGENCY: IV211ti (dd'_„_,-•. <br /> ADDRESS: e Al411.- %.? AJklIn CY{ <br /> PHONE:, PD03 q4ir-` J kiss FACSIMILE: opci <br /> TENTATIVE'APPOINTMENT DATE: ),�00 <br /> (Phase allow 10 business day;tram date of application submittal) <br /> CHECK BOX TO EXPEDITE-REQUEST-593.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Ky_ i[a --- DATE I24e L- <br /> Department Use Only <br /> FILE ADDRESS - UNIT <br /> lZ145 ❑ Unit 1 <br /> a '79 grtin n(I Vr. o._,e76EE '}�j <br /> 3. .. w Ttog0 •—/Y f F a^'......._Itill. cw ._ Unit 2 3 <br /> .M u <br /> F Lml, I✓1 unit 3 (x <br /> r soe,c 11 n1. ;I.�..nen stv�ns "P La;)l . ` <br /> I. Su t17Yo rJ, f k /FF ow 'an' - Oki Unit 4 <br /> I(W'f "r2n+1� (yFJy;axv iyn, �W. .__...._ <br /> an C.) Unit 5 <br /> 10. S.va GJIM f 11446 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ADATEMENT St SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FAciLrTY ❑ SOLID WASTE VEHICLE <br /> lL1 UNDERGROUND TANK(MONITORiNGIREMOVAL) ❑ DOG KENNEL M DAIRY <br /> »x HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 18L PKG TREATMENT PLANT <br /> ❑ TIERED PERMrrTFD FACILITY ❑ MOTELIROTEL ❑ PUMPER TR1ICK/YARDK:HEM TOILETS <br /> ❑ TATTOOIBOOY PIERCING O POOL'SPA M LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 1, List up to ten addresses in the space above. Select the type(s)of files from the list above wy chocking <br /> the appropriate box(as), At least one file type MUST be selected. Fax to(2091 464-0133 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 riles <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 EMD staff at the expense <br /> of the applicant. Future rile 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 /> CON FIRMED-AP..POINTMENT'DATE __ TIME <br /> DATE C6NFIPMFD PHONE FAX -INfTiALS <br /> REVIEWED YES NO REVIEW DATE <br /> -..__...—..-- <br />