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Sep 09 2009 2: 1GPM THE UPS STORE #2503 91 --251772 p. 1 <br /> 10/24/200 6 <br /> 31 4640139 ENV_TRONMENTAL HEALTH Y PAGE-01.. <br /> SAN JOAQUIN COUYTY <br /> EN"RONMNX'AL IUALTH DEPARTMENT <br /> SEP 0 9 2009 304 East Weber Avenue, 3'1 Ploox, Stockton, CA 95202-2708 / <br /> ENVIRUNiVILNT HEALTH <br /> Telephone: (209)468-3420 Fax:(209) 464.0138 Web: www.ajPv,orj � ✓_ <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> l� <br /> APPLICADtT- SUSINi'SWAGENCY: <br /> ADDRESS; Co ^- .",�.� .r ,}• G( <br /> PHONi's(1)t �� PHON!!(2): AC$iSAfL�: Z G g �- <br /> �� TENTATIVE'APPOIN'TIM0 DATE' Tuna: <br /> (NOVA allow iD bu0teaa days tr; •Opplios W aubrnkW-'raWarehro only-must he aenArvn <br /> / NECK am TO WIME RMUEST-111"1 4 H OR CHFC OI4lY)-REQUEST pfxacl saEf7 Ift 8 Itt, E8 Y5 <br /> ` G DATE d <br /> SIGNATURE OF APPLICANT <br /> Elactranlc Information: [J List© Map-Descriptlon: <br /> FILE 9S F-1-113 USE ONLY <br /> BtrKt M Street Name C9lY Usntc 1 \� <br /> 6,. Unit s <br /> 2, <br /> 3, <br /> 6. Un-94 <br /> 7. � .i+ ` ❑ Unit 6 <br /> d• <br /> U Unit g <br /> t3 Ific Date mange of InforMtlon Rpquestod: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Q>♦IOUi1N0p�AT11A'WT ❑BoLmVIIA8T7!iFA 1 , <br /> NDSKraWNUTAW(USTICLImU'SM�) ❑Food 4ABAr V WAMTM ( I yl( T` <br /> Rcu muF"(NoR-LOP? o Doo FAmr Uf' <br /> MHMRMMTMMC(MGMYdWtiWR 91N' Q CHICISIN l L i7 w� A�jRttAT1tlN7PLANT <br /> WAsra ormmATOR OIL ❑CHRMMvmLiaTEL la PUWM rRuacrY �e Tnrtisrrt a I(flI4 I <br /> A0TWj=r"mr1%UFAG1UTY r7 Paa►lsaA ❑LAkV We APPLICATI0K ITE& <br /> ❑'YAtTUW coy pIoRma 0 VNM tpumm offlic TYI <br /> C3 MICICALWASTR FAC.m µOtIDAy� rDAv X00 AM•6:DD!'ll • ExgLUDING'', OUDAYL <br /> yy�AND 8X"4Pi:MTRSCORDe At AWULABti 1•Dlt tR6v�►v " <br /> t. List up to <br /> e a <br /> tan addntsees In the sPaobove• Select the ty*s)of flies from the list*bow by ohpoklnq he■ppropriete <br /> r 1 ve Addte95 <br /> box(as). At loaet one fife typo muwr be a4wctad. ll ia' rerwlwd after <br /> r,npes mill not be OCcOPW-for&ddttlonel asslat&nce,with ftio addrrre•s�►,aontset the END.App C>R� <br /> ;pa will be praesesed the next business day. will lee earstlnned a�proxlmetely tan <br /> 3 otntmerlt for revfer+ <br /> 2. Tha 9M will notify the appt(oent If flfry SHO tike exist- A+T APP <br /> days after"10 Of Witoatkm- The Illes will ba hold for IN roexlmum of five busln�days for review, AppolntTnetTb <br /> should be scheduled aacordinply. licaition MOO b4 <br /> 3. Mlle that <br /> the 1 In worked <br /> Q n by EHD staff may not be I'll" d torr erailable for roTfiwr. A *PP <br /> submitteds of iiia appltoauTt <br /> 4. Any Ells►not rstarr>.d in tM cove condition ee rsleaeed'R'l11�norUan�sd�t:Hp��at ine�Pe" <br /> Future lite mturr d I ftp►Barrie Opp, may toqulre a$96.00 deposit prior to MYI*w. <br /> LNC USE ONLY <br /> -(0- 3 <br />