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02/11/05 17:27 FAX 40898805' CALIFORNIA PAPERBOARD U001 <br /> U <br /> t-mLi LUU NUMCF-r% <br /> FFCEIVE0 SAN JOAQUIN COUNTY <br /> E1 NvIRONM1.NTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,Sri Floor, Stockton, CA 95202-2709 <br /> 0*7 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www-sjSov.org/ehd <br /> pUBLIC "CORT)S RELEASE AppLICATION . - <br /> �` BUSINESS/AGENCY: t-AL/fd <br /> A.PPLICANT: b <br /> ADDRESS; FACSIMILE: 4O8' 98Q D <br /> -7 r (2): <br /> PHONE(1): PHONE ' Time; <br /> TENTATIVE`APPOIN-rMENI EDME: <br /> (please Allow 10 business days from date Ot appllcatfonsubmittal-•raQ�ES7lPR0Cl:SSED tN 3 BUSINESS DAYS <br /> c;HECK 60x TO EXPEDITE REQUEST-593.D0 FEE(CASH OR CN1=CK ONLY)- DATF /— <br /> GIGNArURE OF APPLICANT <br /> 'JNIT DISTRIDUTION <br /> Unit 1 ❑ unit 2 D Tilt 3 nit 4 0 Unit 6 b Unit 6 pU'vr(elaclrGnlUlistslmsps) <br /> FILE ADDRESS EHD USE ONLY <br /> city <br /> Street Name � <br /> 5trgflt 9 <br /> 4. <br /> i 6,- <br /> 1 77. <br /> u. to pd <br /> Snocific Date Range of information Request d:From <br /> T I0 SOLI <br /> ENVIRONMENTAL HEALTH DEPARTMENSOLID <br /> v ©HOUSI.'`iG aBATEIIdENT SD WASTE FAGItJTYl�EK1cLE <br /> iC UNnFROROUND TANK(UST)CLEANUP SR£(LOP) 173 FOOD FAULITY o WASTE!YORE <br /> CE U7Nca CLEANUP SITE(NoN-LOP) 0 QOD KENNEL ❑DAIRY <br /> XC UNOERGROUNDTANK(Mo aYORiNGIPcMOVAL) ❑CHICKEN RANCH0 WASTCWAYER TREATMENT PLANT <br /> HA7ARDOUSWAsYEGENERA7oR ❑MOTELMOTEL PU ERTRUGKIARD(CHE+�TOILETS <br /> 0 TIF.AED PERMimD FACILITY 11 QOOLISPA 0 LAND USE APPLICATION SITES <br /> 7 TATTOOIDODY PIERCING n Ol Hkk(PLEASE SPECIFY) <br /> -MEDICAL WASTE FACILITY <br /> WELL AND SEPTIC-PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONRAY-FRIDAY B:OQ AM-S:OOPm EXGLUOINO HO DJ1Y5_ <br /> t. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the <br /> appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to thes <br /> , c <br /> indicated above. Address ranges will not be accepted—foradditional the next buts Hess day. file addresses, conte <br /> the EHD.Applications received after 3,00 pm will t}0 processed <br /> 2_ The F-HO wilt notify <br /> en Oe daysapplicant <br /> f any E+Hof application.files <br /> on. The ist. An appointment <br /> los will be held for a maXIMUM o fl a business <br /> approximately t ( ) <br /> days for review. Appointments should be scheduled accordingly. <br /> 3. A Ile 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 /> A. Any file not retumed in the same condition as released will be reorganized by EHD staff at the expensa of thI <br /> applicant. Future file reviews by the same applicant may require a$93-00 deposit prior to review. <br /> 1'1'_3107 _ <br /> [y �9yd HI-IV3H -1V1N9WN0N1lAN3 s;EZ0ti9V zti 9T GOOZ/11:/ZI <br />