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----l_'I 15/2003 16: 55 FAX 14002/002 <br /> OATSRP-CEIYED r/I (� SAN J OA Qj� COUNTY <br /> fE - [l V L�LJ ENVM0NMENTAL HEALTH DEPARTMENT <br /> 304 E Webcr Ave 3`d Floor Stockton, CA 95205 <br /> 209 464-0139 Web:rvtivsv.co.sau joaquin.ca uslehd <br /> N O V 1 6 l��.g) 468-3420 l�'az ( ) <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE A:PFLTCAnbN <br /> PERMIT SERVI <br /> BUSLNESWAGENCY: ri <br /> APPLICANT_11►,f� <br /> 4 FAGSHAII..E. <br /> PHONE: 7 — <br /> E <br /> jENfAT5E'APPOIrmn <br /> ENT DATE: .� Tuna <br /> (Please allow 10 business days from data of aPPli�°A submittal? <br /> CHECK BOX TO E]tPEOITE REQUEST 593.00 FEE-REQU1_ST PROCESSED IN]BUSINESS DAY'SATE ___ �_ � /O r- <br /> SIGNATURE OF APPOCANT DepamTcri Use OnN <br /> UNIT , <br /> FILE ADDRESS <br /> Unit 1 <br /> 295 unit 2 '°`.,• <br /> a <br /> ,`"�, +. 36,94 Unit 3 ` <br /> I� <br /> I" p,� - tA 7 ske! <br /> walkIL saw 12 �' tV F [� Unit 5 <br /> s.� <br /> 10. Stred ' i���t�. �•. <br /> ENVIRONMENTAL 14EALTH DEPARTMENT FILES <br /> CENUPS ( OPI0 HOUSING ABATEMENT uLsouo wASTr-FAcIL(TY <br /> UNDERGROUND TANK(UST) <br /> ❑ FOOD FACILITY C3soLID WASTE VEHIGLE <br /> OTHER CLEANUP SITE(NON�OP) ®-DAIRY <br /> la- UNDERGROUND TANK(TAONITORINGlREMOVAL) 0 DOG KENNEL 9-PKG lREAT1AEN f PLANT <br /> Z HAIpRDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PUMPERTRUCK[YARDICHEII TOILETS <br /> ❑ TIERED PERUFME)FACILITY ❑ PO LISPOTEL to LAND USE APPL1cAmON srrEs <br /> ❑ TATf00180DY PIERCING ❑ POOLISPA <br /> - O OTHER(PLEASE SPECIFY) <br /> d MEDICAL WASTE FACILRY <br /> �. List up to Cert addresses in the space above. Select the type(s) of files from the list aboya by checking <br /> tha 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 /> HD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> 2_ f_ <br /> cation, The <br /> approximately five business days but no later than tan (10) dots o ntmi.es <br /> ents should eceipt of be scheduled <br /> will be held for a rnaxilnum of five business days for review. Arae <br /> accordingly. <br /> - worked on by END staff may not be immediately available for review. <br /> 3_ A file that is actively being Ane <br /> application may be submitted when the file is available. <br /> at the expense <br /> q Any file not returned in the same condition by <br /> as same apply wilt may require l be iza ed by OHD posit prior to review. <br /> of the applicant. Future file reviews <br /> T>~NT <br /> ATNE appointment dates must be confirmed with EHD staff. <br /> 5 ' <br /> 6. TENT ATVs received after 3:00 pm will.be processed the next business day. <br /> ApplictlOn <br /> -TIM -` '��' -�-��•'; .> ��:�=- `• . <br /> FREVIEWEID <br /> t PHONE FAX . Ls <br /> YES NO zEVIEN DATE' <br />