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09/09/2005 13:52 530676E i STRATUS NO CALIF - PAGE 01/01 <br /> U U' <br /> 65/11/2804 14:50 4640138 •ENt/IROhi`gEN7AL HEALTH rJ ������R <br /> DATE RECEIVED SAN JOAQUIN COUN Y In X11 <br /> ]EN 0NMF,nAX HEALTH A)EPARTMENx' SEP - 9 2005 . <br /> 344 E Weber Ave 314 noor Stockton,CA 95205 <br /> (209)468-3420 Fax:(209)464-0138 Web:www,co.san joaquin-ca-WEW1RONMENT HEALTH <br /> PERMIT/SERVICES <br /> PUBLIC RECOFDS RELEASE APP.LICA TIOiN <br /> APPLICANT: � � i4 i �,__13uSiNE3S/AGEidCY: / ►tlr�t <br /> AD1y1iESS:�,35 Cain P � S k 55y (a, , & � � 8 <br /> HONE' o L FACSIMILE 5 X7704-4-i0o 5 <br /> TENTATIVE•APPOINTMENT DATE: Tine: <br /> (please allow 10 businasa days from date of appiicatlon submittal) <br /> ® CHECK SOX TO EXPIEDIT'E REQUEST-$93.00/pFEE—REQUEST PROCESSEM IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT (Jr -fir ,,.�- DATE <br /> Department Use OnlY <br /> FIL,15.ADbRESS UNrr <br /> 1. stoedo LIC, ❑ unit, <br /> a ay Unit 2 <br /> I. S <br /> a " 3 <br /> e. WWI d <br /> sweet Unit 4 <br /> soe� p Unit 5 <br /> 9. StfLYt <br /> 10, Std <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK NS'i?CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE-FACILITY <br /> 0 OTHER CLEANUP$ITE(NON-IADP) M FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UND881WROUND TANK(MONRORINGIREMOVAL) 17 DOG KENNEL 13 PXGDAIT <br /> 17 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PISG TREATMENT PLANT <br /> L0 TIERED PERM; E17 FACILITY L't bAOTE1HOTEL t7 PUMPER TRUCKIYARD/CHEW TOILETS <br /> ❑ TATTOOlNODY PIERCING ❑ POOLISPA l.AlIID 115E APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> �. <br /> List up#o ten addresses in the space above. Select the type(s)of tiles from the list above by checking <br /> the appropriate box(es). At(east one file type MUST be selected. Fax to 20 464.0138 or rail to the <br /> address indica#ed hove. appointment for f'evlew will be confirmed <br /> 2. EHD will notify the applicant n any EHD files exist An appsThe <br /> approximately five business days but no later than ten(10).days after receipt <br /> ouOf pplld laescheduledtion- �Ies <br /> will be held for a r,axlrnUin of five business daysfor review. Appointments <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A now <br /> application may be submitted when the file is available. EHD staff at the <br /> 4. Any file not returned+n the same conditionthe Sar l easapplicant may requinized re a$93 04 deposit prior to review. <br /> of the applicant Future file reviews by <br /> $. <br /> Applications <br /> p lNcaa 1 ns appointment <br /> cpeived efterdates must be 3 0 pm wilt beprocesseded rths ext business dey. <br /> 6. AF►t' , <br /> CONFIRMED APPOINTMtNT DATE TIME <br /> DATE CONFIRMED <br /> PHONE . FAx wrhAE,..s <br /> 1 REVIEWED YES NO REVD DATE <br /> Ercn as.n�aoe• <br />