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11/10/2003 16:30 4G40 <br /> ENVIP.ONMEhf1 ALTH <br /> DAT-RcGEIVEq,. �r e�y PAGE . 02 <br /> IN I AN OAQMN C O E HO LOG NUtit3EFt <br /> ►J <br /> E-NVI,O1NWMNTAL HEALTHDEP�A-RTIV1`ENT <br /> TJO U 1 0 2 304 E Weber Avc 3 Floor Stooktvnn, CA 95'205 <br /> 9)468-3420 Fax: (209) 464-0138 Web: www.co.sazt-joaqu n caus/ehd <br /> :NViRUJJiIlENT yEtiLTFj <br /> PERN!1T,''Km/jCf:c PUBLIC RECORDS )RZL:EASt "PLICA' N <br /> APPLICANT:_l C��{0✓1 co�-6 t M-< BUSINUS1AGEUCY:_ i�� CC?✓I S(/'l�tf—S <br /> ADOREss: <br /> HONE:_- 2s Zg3 6Od d }c f d S FACSIMILE:. j�'2S 2-�b 3 6 f�Z <br /> TENTATIVE'APPOiN-RiENT DATE: 1 l 7('C?$ lima: 10"00 <br /> r3 <br /> (Please allow 10 bL*Inoss days from date of applionuon submittal) <br /> Q CHECK BOX TO EXPEDITE REQUEST-59 E ECIUEST PROCESSED iN 3 BUSItiESS DAYS <br /> 7r <br /> SIGNATURI;OF APPLICANT DATE _j_� t��l S <br /> Department Usa Ony <br /> AL tl 5 FILE AODRI=S UNiT <br /> t s r+ Z O r I v d d Y2,G n"�c c v Ct <br /> Z s�U 5 u1r✓sd L 'w� <br /> Rd Te" ; ( ❑ Unit 1 <br /> z srm 23 sMCA, /Y V-11-2!x �� 2L4. -e 1 I.U.._. re, L' RJ a >'ac- aV�-P C1 tJflit2_ <br /> — i <br /> a sr-or, ray N�fi •w+ S ft�.�i0-•n Se- %%�•c. 6"`"`S <br /> 7. <br /> 9. 3r.Y_t G <br /> ta. Sr!-r ON c. n <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FiL <br /> UNDERGROUND TANK(UST)CLEANUP SiTE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACiLI'(Y <br /> P1 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VirHiCLE , <br /> UNDERGROUND TANK(M 01MORINOMM OVAL) D DOG KENNEL. Q t)AIRY <br /> HAZAIMOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMrTTED FACILITY ❑ MOTELIHO'iEL ❑ PUMPER TRUCK/YARDICHEM TO <br /> ❑ TATTOOISODY PIERCING ❑ POOLrsPA C3 LAND USE APPLICATION srTES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE.SPECiFY) <br /> 1. List up to ten addresses in the space Above. Select the type(s) of files from the ll.;t above by checking <br /> the appropriate box(es). At least one file type MUST be'selected. Eax fD-(Z091464-0138 or mail to the <br /> address Indicated above. <br /> 21 EHD will notify the applicant if any END files exist.,An appointment for review will be confirmed <br /> approximat®ly five business days but no'later than ten(10)days after receipt of application. The tiles. <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 END staff may not be Immediately available for review. A new <br /> application may be submitted when the Elle is available. <br /> 4. Any filo not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates rnust be confirmed with EHD staff, <br /> 61 Applications received after 3:00 pm will be processed the next b.usiness day,• . <br /> CONFIRMED APPOINTMENT DATE : TiME <br /> DAT5 CONFIRMED PHONE FAX INITIALS'• <br /> REIVIEWED - YES NO REVIEW RATE, <br /> ` °aa 't- ^ ,..t <br /> Pel. ca.wrem cu, Ito IiIAe- <br /> . <br /> to 39yd -1j:;; : C�,,�C� <br /> CSS) SINbllf1SN00 I3V . IZZ9E8Z9Z6 b£:Lt £®0Z/01/11 <br />