Laserfiche WebLink
DEC -13-2004 12:53 �ONDOR EARTH TECH 209 532 0773 P.01i0: <br />PATE RECEIVED EFip LOG NVN � <br />A1~i JOAQUIN CO•UZ <br />DEC 1 ;3 2004 304 E Webe,�.Ave 3" door Stockton, CA 95.205 <br />(209) 46$3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.caus/chd <br />P I R F,� ' ,: ;. , i ,_, F S PUBLIC RECO"S RELEASE APPLICATION <br />PLICATION <br />APPt.1CANT• ? PA / it Ll ` A ��• SUSINESSIAGENCY: <br />ADDRESS: <br />TENTATIVE` APPotNTMENr DATE:ec>a <br />(Please allow IQ buslnsm days from date of appllaatlon submltial) <br />CHECK SOX To EXPEDITE R�T - $33.00 FEE QUEST Pa0CESZED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT � -- REDATE 11t C— <br />Department Use Only <br />UNIT <br />[a Unit 1 <br />�-' Unit 2 <br />Unit 3 <br />Unit 4 <br />5 <br />ENVIRONMENTAL HEALTH DEPARTMENT /ttFILES <br />UNDERGPOUND TANK (UST) CLEANUP SITE (L.Ot') 0 HOUSING A13ATEMENT � souD WASTE F . <br />OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY SOLID WASTE <br />UNDERGROUND TANK (MONITORING/REMOYAL) 0 DOG KENNEL AT DAIRY <br />HAZARDOUS WASTE GENERATOR CHICKEN RANCH 4 PKG TREATMENT PLANT <br />TIERED PERMITTED FACILITY Q MOTEUHDTEL O PUMPER TRUCK(YARDJCHEM TOILETS <br />0 TATTOMODY PIERCING D POOUSPA )2� LAND USE APPLICATION SrI-ES <br />319 MEDICAL WASTE FAGILrrY n OTHER (PLEASE SPECWY) <br />1. t.ist up to ten addresses in the space above_ Select the type(s) of files from the list aboye py checking <br />the appropriate boX(es). At least one file type MUST be selected. Kix to (209) 4640438 or mail to the <br />address Indicated above. <br />2- FFD will notify the applicant If . ny EHb files exist An appointment for review will be confirmed <br />approxtrnately five business days but no later than ten (10) days after receipt of application. The flies <br />will be held for a maximum Of five business days for review. Appointments should lie scheduled <br />accordingly. <br />3. A file that Is aeUvelyr being worked on by EHD staff may not be immediately available for review. A net <br />application may be submitted when the file Is available. <br />4. Any file not returned in the sante condition as released will be reorganizer) by EHO staff at the expens <br />of the applicant Feature file reviews by the same applimnt may require a $93.00 deposit prior to-raviai <br />5. *TFN TAT VE appointment dates mutt ba confirmed with EHD staff. <br />t• Applications received after 3.00 pin will be processed the next buslnc:.-s day. <br />+CONFIF.MED APPOINTMENT AA )F- TiML a <br />is <br />DATE CONFIRMED 'PHONF- FAX' INITIALS'. _ <br />REVIEWED YES NO REVIEW DATE' <br />TOTAL P.O: <br />FILE ADDRESS <br />Cefa <br />Gam► ►J <br />z , sty <br />-7- <br />y <br />ami ' <br />s <br />e C7V <br />j <br />& <br />0 PE"►. 6-f b c <br />60 UTAH l KfIO�r <br />V2,4 -,r <br />a. stcee� <br />10- Streety <br />N veN Co MoSQur� } v��ay <br />(ON GIf~IG RAc�Ra+ ►rcra4L 3 <br />krr+ wy <br />L' C-iYj;f' <br />(a, i <br />Department Use Only <br />UNIT <br />[a Unit 1 <br />�-' Unit 2 <br />Unit 3 <br />Unit 4 <br />5 <br />ENVIRONMENTAL HEALTH DEPARTMENT /ttFILES <br />UNDERGPOUND TANK (UST) CLEANUP SITE (L.Ot') 0 HOUSING A13ATEMENT � souD WASTE F . <br />OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY SOLID WASTE <br />UNDERGROUND TANK (MONITORING/REMOYAL) 0 DOG KENNEL AT DAIRY <br />HAZARDOUS WASTE GENERATOR CHICKEN RANCH 4 PKG TREATMENT PLANT <br />TIERED PERMITTED FACILITY Q MOTEUHDTEL O PUMPER TRUCK(YARDJCHEM TOILETS <br />0 TATTOMODY PIERCING D POOUSPA )2� LAND USE APPLICATION SrI-ES <br />319 MEDICAL WASTE FAGILrrY n OTHER (PLEASE SPECWY) <br />1. t.ist up to ten addresses in the space above_ Select the type(s) of files from the list aboye py checking <br />the appropriate boX(es). At least one file type MUST be selected. Kix to (209) 4640438 or mail to the <br />address Indicated above. <br />2- FFD will notify the applicant If . ny EHb files exist An appointment for review will be confirmed <br />approxtrnately five business days but no later than ten (10) days after receipt of application. The flies <br />will be held for a maximum Of five business days for review. Appointments should lie scheduled <br />accordingly. <br />3. A file that Is aeUvelyr being worked on by EHD staff may not be immediately available for review. A net <br />application may be submitted when the file Is available. <br />4. Any file not returned in the sante condition as released will be reorganizer) by EHO staff at the expens <br />of the applicant Feature file reviews by the same applimnt may require a $93.00 deposit prior to-raviai <br />5. *TFN TAT VE appointment dates mutt ba confirmed with EHD staff. <br />t• Applications received after 3.00 pin will be processed the next buslnc:.-s day. <br />+CONFIF.MED APPOINTMENT AA )F- TiML a <br />is <br />DATE CONFIRMED 'PHONF- FAX' INITIALS'. _ <br />REVIEWED YES NO REVIEW DATE' <br />TOTAL P.O: <br />