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' EHD LOG NUMBER° T!MwIEDD <br /> _ SAN -JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUL 2 7 . <br /> . 304E Weber Ave 3`j Floor Stockton,CA 95205 <br /> 468-3420 Fax, (209)464-0138 Web: www,co.san-joaquin.ca.us/chd <br /> ENVIRONMENT HEALTH q&°b - S-5 z <br /> R PERMiRSERVICES PUBLIC FXCORllS RELEASE "PLICATION <br /> APPLICANT: V0,4" I BUSINESSIAGENC(Y: <br /> ADDRESS: (9&5) <br /> p <br /> PHONE: L !/f ' FACSIMILE: L-!LS <br /> TENTATIVE*APPOINTMENT HATE: �► <br /> (Please allow 10 business di horn date a apple ion sfmittaq <br /> __-WCHECK BOX TO EXPEDITE REQUEST 93.00 EE—REQUE T PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 27 D <br /> bepartment Use Only <br /> UNIT <br /> u r FILE ADDRESS __ <br /> Gu T•YrxL�,��. � Unit 1 <br /> sKm <br /> z. Suevt Z 5D0 W i 1�—� <br /> W ._il}h 5ftc&_' Cn�_ � �� ! unlit 2 <br /> r <br /> Cje� nit 3� nit 4slmett.. .. GN <br /> _ l 5 <br /> Cn <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 14UNDERGROUND TANK(UST)CLEANUP SITE(LOP) d H $01-113 WASTE FACILITYOUSING ABATEMENT 0 SOLID WASTE VEHICLE <br /> � OTHER CLEMUP SITE(NON-LOP) O FOOD FACILITY <br /> AL) ❑ DOG KENNEL ❑ DAIRY <br /> UNDERGROUND TANK(MONITORING)REMOV <br /> d HAZAR13OUS WASTE GENERATOR ❑ CHICKEN RANCH d PKGPumPFA TR IENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTBtJHOTEL ❑ LAND RE APPLICAT10N SIV TOILETS <br /> ❑ rATTOOIsOoY PIERCING M POOLISPA t7 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> I. List up to ten addresses in the space above. Select the type(S)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209}46a-0138 ar mail to the i <br /> address indicated hove. <br /> 2, EHD will notify the applicant if any EHD files exist. An appointment for review will confirmed <br /> days after receipt of application. The files <br /> approximately five business days but no later than ten(t0) <br /> will be held for a maximum of five business days for review. Appointments shoulldd <br /> be scheduled <br /> accordingly. <br /> 3. A file 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 returned In the same condition as released will be reorganized rquire 3y 0 deposit prstaff atior expense <br /> of the applicant. Future file reviews by the same applicant may <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> g. Applications received after 3:D0 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> PATE CONFIRMED PHONI; FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EXn fE.02 <br /> IM20W <br />