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43/24/2004 10:35 FAX 209 9480621 0002/002 <br /> I <br /> ATE'R.EC2 IVSD SAN JOAQ COUNTS <br /> ENVIRONMENTAL HEAuR DEPARTMENT <br /> MAR 2 4 2004 304 E Weber'Avc 3'd Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax! (209) <br /> 464-0138 Web:wWW.co_san-1oauincaclehdENVRDEVL�J1 HEALIH <br /> Li3 <br /> PERMI'PSERVICES PUBLIC CORDS RELEASE APPLICATION 1007 <br /> APPLICANT: fav lS an/ BUSINESWAGENCY: 1�rlelNwef, o! <br /> ADDRESS_ <br /> PHONE: vl(1 g �4�rd' I c7i 5' FACS[MILE: 09 - <br /> TENTATIVE"APPOINTMENT DATE: 31,qlov 7'„-fte: <br /> (Please allow 10 buslr"as days From date of application subm4t4l) <br /> 21 nn <br /> CHECK BOX TO EXPEDITE REQUEST".$33.00 FEE—REQUEST PROCESSED IN 3 BUS[NESS DAYS <br /> SIGNATURE OF APPLICANT DATE L3 Div 16V <br /> Departrrren Ilse only <br /> FILE ADDRESS UNIT <br /> ,. Z l v,41 EI Unit 1 <br /> 2. Scree! A dc�--row G Ile, 4 <br /> ,`.r !o�� �" — ►Uor F}V PSI IaR o�lys7- �� <br /> 5. s� MP—Unit 2 <br /> 3 �>ra Oty ~ <br /> s, suese rAy Unit 3 <br /> r. saes, Unit 4 <br /> a, su+9et C-*, uniuwariwi: ii loft <br /> 9. Sleet c ❑ Unit 5 <br /> ?f�R6 J2004 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP S1T�(LOP) ❑ HOMING AB/ITEMENI > " 5OL6R WASE FACJI_iiY <br /> OTHER CLEANUP SI'Z'E(NON-LOP) 0 FOOD FACILrrY ❑ SOLID WASTE VEHICLE <br /> Er UNDERGROUND TANK(MONrTORINGAIEMOVAJ_) ❑ DOG KENNEL tai DAIRY <br /> jZF HAZARDOUS WASTE GENERATOR ❑ CHICKEN RAN(>i Sid PKG TREATMENT PLANT <br /> D TIERED PERMITTED FACitl1Y ❑ MOTEL1HOTEL, ❑ PUMPER TRUCMARDtCHC9 TOILETS <br /> ❑ TATTOOMODY PIERCING ❑ POOlJSPA )A LAND USE:APPLICATION SITES <br /> ❑ MEDICAL.WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) _ <br /> 1. List up to ten addresses in the space above- Select the type(s) of flies from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 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 files <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 EMD'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 EHD staff at the expense <br /> of the applicant. Future file reviews by the sante applicant may require a$93.00 deposit pn to ev w. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. } , <br /> " Applications received after 3:00 pm will be processed the next business day v <br /> l <br /> GtNd,RMt~C] APPOINTMENT <br /> AT :s T1M1= <br /> DATE.CONI <br /> F RMS D <br /> .- ,.PHONE I . FAX ;�•''�a1�13.�Ai:s ;r+' <br /> RlEvi,EVV.ED ,. YES 'NO REVIEW DATE EHO 48-W-006 <br /> &WO03 <br />