Laserfiche WebLink
"`12007 14:46 9497231x54 FREY ENVIRONMENTAL PAGE 02/02 <br /> PAGE 01 <br /> 112006 11:22 4540138 _ <br /> ENVIRONMENTAL HEALTHI rnu LuU rn iMlitH <br /> ,e�blvru SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH MPAKTMy,NT <br /> 304 Fast Weber Avenue, 3 Floor, Stockton,CA 952o2-2708 or /e <br /> Telephone: (209)468-3420 Fax: (209)464-0138 W015'wwwsjg 8 (�l• <br /> PUBLIC R CORDSRE+LEASEAPPLICATION A6Pr lHc, <br /> BUSINESSIAGENCY: r n G^ irHC� <br /> Von <br /> AI�PLIGANY.�-'�`•`:'�. �fYA)� f�-kft � 2l� o IT �G(� �/ �I ZG6/3 <br /> ADDRESS: 7,117—A L FACSIMILE: <br /> PHONE 01: �qL( 72-S— 646 PHONE(2): <br /> lime:,_._,_.--d) <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Please allow 10 business days from date of 11"FGtien submhtal-•Tentative enly-must de Confirm <br /> 17 CHECK PDX TO EXPEDITE REQUEST,$96.00 FEE(CASH OR CHECK ONLY)-RECIUEBT PROCESSED INC U��SDAYS <br /> � <br /> DATE J <br /> SIGNATURE OF APPLICANT <br /> Electronic Information: ❑List❑Map—Description: <br /> EMD USE ONLY <br /> FILE ADDRESS ❑ Unit t <br /> Street Name City <br /> SlreetN 5��.1 _ o�, <br /> 1. 2132 Alii 05A d- 3� 29 ❑ unitz <br /> 2. (� <br /> Unit 3 <br /> 3. <br /> 4. — Unit 4 <br /> 5. .. <br /> 6. ❑ Unit S <br /> 7. <br /> Units <br /> 9. <br /> 10. to <br /> Specific Date Range of Information Requested:From <br /> ENVIRONMENTAL HEALTH DEPARTMENTFILES SO <br /> OID wASTE FACILITYIVEHICLE <br /> CLEANUP SITE(LOP) O HOIISINO ABATEMENT UWASTE TIRE <br /> NDERGROUND TANK(UST) (] F000 FACILITY 0 DAIRY <br /> icoTHER CLEANUP SITE(NON-LOP) 13 DOE,KENNEL 0 WASTEWATER TREATMENT PLANT <br /> PEROROUNI)TANK(MONITORINGIREMOVAL) 0CmICKEH RANCH o PNMPERTRuCKIYAR*CHEMTO"Em <br /> HATARDOUS WASTE GENERATOR 0 MOTEL/HOTEL p LAND USE APPLICATION SITES <br /> fl TIERED PERMITTED FACILITY 0 POOLISPA <br /> O TATTOOt9cDY PIERCING I]OTHER(PLEASE SPECIFY) ExCLUDMG HOLIDAY&. <br /> ❑MEDICAL WASTe FACILITY (ate <br /> WELL AND SEPTIC PERMIT itEWRO3 ARE AVAILABLE FORRE'TIEDffllesfrom the list bov by cheoking the appropT <br /> 1. List Up to ten addresses In the <br /> space above. Select the type(q) <br /> ii to ha address in�cationsDied brecaived aat ss <br /> box(esl typo file addresses,contact the EHD.ApP <br /> At least one filet a MUST be selected. Fax to 209 464'01 or a <br /> ranges will not be anCapted—for <br /> adds JOARI sirtance With approximately ten(10) <br /> 3:00 pm will be processed the appointment for review will be confirmed app ointments <br /> 2. Tho EHD will notify the applicant if any C"D files exist. An app <br /> days after receipt of appiioatldn• The files will be hold for a maximum of flue business days for review. App <br /> should be scheduled accordingly. EHO staff may not be Immediately available for revlDw• Anew aPPlh'twn maybe <br /> 3. Afila that Is actively being Worked on by EHD staff at the expense of the applicant, <br /> submitted when the fila is available. <br /> be reorganized by <br /> 4. Any file not returned inth s sr a applicant may relqulre a$9eased 15 00 deposit prior to review. <br /> Future file reviews by the <br /> EHD USE ONLY <br /> FMn A&9A 911D(I <br />