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11 / 7, 0 / 2003 I6 : 30 4640134 - ENVIRONMENTAL PAGE 02 <br /> DL4. rl _'. QF4VtEV _. EHD Lou NUMUER <br /> } L SAN JOAQMN COUNT'S.' <br /> ! ENVIRONIV NTAL HEALwa DEPARTmENC <br /> NOV j Z 304 E Weber Avc 3'° k Stockton CA 95205 / <br /> �4) 468-3420 Fax- (209) 464-0138 Web : <br /> www.cosan joaquin.ca.us/ehd I <br /> cNVIRUNMEN i HE 1LTH <br /> PERMIT/SFR /I ^Fc PUBLIC RECORDS RELEAS7�" APPLICAnON <br /> APPLICANT: lLllA)1�2V1 CP 1V�XJ( r M -5 BUSINE$SIAGENCY: t/ ( ty <br /> ADOREss: 9 � 0 "mob D la 610, sr� 200 �o�� c vs s y2` <br /> HONE: �25 Z $3 6pdo k ftl $- FACSIMILE: <br /> TENTATIVE" APPOINTMENT DATE: 1 1 1f17 l/ cr$ Tune: I? 'A 0 O <br /> r� (Please allow 10 buslness daYR from date of applitatlon submittal) <br /> w CHECK BOX TO EXPEDITE REQUEST EgVEST PROCESSED IN 3 BUSINESS DAY$ <br /> .f$IGNATURE OF APPLICANTpDATE I J f I0 03 <br /> Department Uso Only <br /> FILE ADDRESS UNIT <br /> stretl <br /> Zq qO Iv c4u Tf4 L <br /> z a"& 75 c Jehd Lev: RJ a ri4 [3 Unit 1 <br /> A. e 1 mot r L' RJ city Yeo ❑ UO2 <br /> 5. aaBa! <br /> 5 Ire^ c <br /> tee! I �� sf S ea a n1t4 <br /> a. sW rqL f1�fl ' r� SttiFitj ..� 5; City 7rc 6"`SC4 v/Y <br /> a. R� <br /> oty Q Unit 5 <br /> ENVIRONMENTAL. HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK (USTJ CLEANUP SITE (LOP) 0 HOUSING A13ATEMENT 0 SOLID WASTE FACILITY <br /> P- OTHER CLEANUP SITE (NDN-LOP) ❑ FOOD FACILITY 0 SOLID WAST£ VEHICLE <br /> UNDERGROUND TANK (MONITORLNGIREMOVAL) O DOG KENNET. ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTIFL 0 PUMPER TRUCKlYARDICHEM Tor <br /> 0 TATTOO/BODY PIERCING 0 POOLISPA G LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILrrY ❑ OTHER (PLEASE SPECIFY) <br /> 1 . 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 §.091 464.0130 ar mail to the <br /> addre,£s Indicated above. <br /> 21 EHD will notify the applicant if any EHD Tiles exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ton (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 EHD 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 appllcarrt. Future file reviews by the same applicant may require a 593.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff, <br /> 6: Applications received after 3:00 pm will bo processed the next business day. <br /> CONFIRMEDAPPOINTMENT DATE �j TIME • _ C dam ] <br /> DATE CONFIRMED PHONE FAX INITIALS ' ' <br /> REVIEWED - YES NO REVIEW DATE• <br /> BUJ �, c W ud &e S Ici s f 44c[; s (/¢ IL r ,� ,I -r,�;4 . ,7 o ( ZRC2 vhZL�) <br /> PeX. La�ret� eie, Ik�> <br /> it 1 ? Q� 1iZ/ Lv JJo (-C)t 7rall <br /> TO 39Vd (AS ) SlNVi-lnSN00 I3V Td T9EBL9d6 bE : LT E996 /0T / TT <br />