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Sent By: Point Environmental; 510 237 1783; May- �04 2:21PM; Page 1/1 <br /> iii Z00414:1111464 ENVIRON ENTAL )�234t TH p <br /> SAN JOAQUrN COUNTY <br /> ENVIRONMENTAL HEALTH I)EPARTBRENT <br /> MAY 1 1 200 304 E Weber Ave P Floor Stockton,CA 95205 : <br /> 1209)468-3420 Fax: (209)464-0138 Web:www.co.san jeaqui1Lca-w1&il Q ' <br /> ENIIIRONPAENT HEALTH <br /> PERMIT/a R�/irF. /PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:+� � � RUMNESSIAGENCY: `,.,1✓L t-O�rel. G�--- .:. - <br /> ApDResB \C.-IcLti rKoI� ��••� . ,(. `t..!��i. <br /> HON@: S c o !Z-3�' l�}`�Z FAMIMILE: <br /> TENTATIVE`APPOINTMENT DATE: <br /> (Please allow 14 busine"days from 0414 of application submittal) <br /> E3 CHECK 80X TO EXPEDITE REQUES -"3.0a RBE--REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT (� <br /> ��. DATE - <br /> 1D: attfrranii aa#Nieir <br /> FILE ADDRESS <br /> B. Btnal C P .... ... <br /> - <br /> . ....•:..:::... <br /> 9. <br /> ShtN <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES .._...'.......... <br /> o HousrHo AaATEMEN7 ❑ SOLIDwKSF <br /> UNDt-XGROUND TANK(UST)c"AMUP SITE(LOP) in FOOD FACILITY C3 SOLidt�ASrE Ii{CL1r:. :. ......::.'•:.::::;<: -:••• <br /> C1 OTHER CLEM Srm(NON--OP) ❑ DOG KENNEL d DAIRY <br /> SIJNDER3RQVND TANK{1s40}IIrOR1NGlREµOVAL) ❑ CHICKEN RANCH a PKG <br /> t7 14AZA MS WASTE GENERA'S ❑ MOTEL44OTFL O PU"Pblt TR1lCKfY�� F�::.' '• <br /> O TIERED PERMnTEO FACV" d POOLISPA a LAND USE'AI'PttLAtNCfl'i 1[ <br /> ❑ TATTOMOOY p-ACING :..:. .... <br /> ❑ MEDICAL WASTE FACUTY D OTHER(PI EIDE SPEd <br /> ace strOVe. Select the type(S)of filas <br /> 1, List up to tan addresses in the sp r.: 1 <br /> the appropriate bOX(es). At least one file type MUST be selected. <br /> jub gs 1n1W9W a1LW!- <br /> 2. EHO will notify the applicant K any END files exist An appointmont for review lwilt f�o:aaei4{ri ,.; <br /> free business days but no later than tan(10)days after receipt Of appli@iC+t1a ;::' {1e►:.... <br /> Approxtmat6ry lntmentsl andulttbc� i�E?d::• :::'• ':::' <br /> will be held fora maximum of five businoss days for review. Appo' <br /> accordingly. <br /> 3, Afile that is activety being worked on by <br /> F-HiOs staff <br /> not be immediately ays ilabl+a forl�ib+ar :An�M. <br /> Opp may be submitted when that antmed by EHD s"..bt`tti 'ditp tiiGo: <br /> 4, Any file not returned in the same condition as releasednt m ill be cert Ire a$43.00 dOpoaitp ttv route r: <br /> of the applicant Future file reviews by the same Sapp Y <br /> 5, *TENTATIVE aQgol od aefnterd3t00 pm wii baes must be Qprh�sssedr he next buniness dray. <br /> • 6, <br /> Applications . <br /> _ TIME ;::::• :: :• ; <br /> CONFIRMED APPOINTMENT DATE <br /> DATE CONFIRMED PHONE FAX <br /> YES I+10 REVIEW DATE <br /> REVIEWED :... <br /> tea, <br />