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12/09/2004 09:49 FAX 916290zmg WKAsENV1RONMENTAL U 002/002 <br /> t, ,<oow 144 <br /> bn1 ENVIRONMENTAL -TH PAGE 01 <br /> CHO LOG WMSEA <br /> - A RECEIVED SAN JOAQUIN COUNTY <br /> ENVJIRONmzNTAL HEALTH DEPARTMNT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquiD.causlohd W <br /> PUBLIC RECO"S RELEASE E APPLICATION <br /> APPLICANT: MA'f -l...w � p- SUSINESSlAGENCY: We• 114 ee -•Ky�q! A.sl'o e.'e.+•t1 <br /> ADDRESS: .30.50 a:^AwC4e.a1 <br /> PwoNC: 9 /4 - .3 ;z2- At 3ti< FACS&WX: 9 6 2 90 -5'4 z7 5 °' <br /> l�ec�.,tiv l� 20 7 <br /> N : 3 v F` l <br /> /TENTATE'APPOU"ENT DATE: :. <br /> (pte"a an"10 0uslrte s days hom date M apWletion su&-r0$I) <br /> CHECK aOX T9 L-XPEDITE REQUEST-$93.00 F -REQUEST P OCEssL..O IN 3 DUSINESs DAYS <br /> DATE <br /> SIGNATUREOF'APPLICANT <br /> Ixoartrnerrt Vao ONy <br /> c FILE ADDRESS UNrr <br /> -5,ov+-1• L:ncel� TocKriA) glP Unit <br /> z sew �0 l.�eSei A✓I M .SToaxT>t <br /> x W e� 7-0cX -ems l X94 ❑ Unit2 <br /> ocrc r"^ <br /> � W We yrs A✓G -S <br /> o W Ws Unit 3 <br /> r, 66 w we ba. i�✓� s ro ter„ y, <br /> s� 0 jwJ <br /> we-A— AuuE" SroUc>e Uniit4 <br /> cA=rs <br /> y a s.ed A N _/3 -27-g,60 - 26 `" ST c fi re ❑ Units <br /> csK+ APN 13 -260_`�O. YK�T✓ /ham y <br /> to. V -d 11J i <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT ❑-'SQLR1 WASTE FACILITY <br /> ,)—< TANK NST)CLEANUP SITE(LOP) ❑ FOOD FACUM P'• O'-SOLID WASTE VEHICLE <br /> �OTHER C49CANUP BRE(NON-LOP) ❑ DOC KENNEL _ ('� 'O DAHtY- <br /> UNDERGROUND TANK(MONITORING!REMOVAL) ❑ CHICKEN RANCH .0 PKG TRLATMEW PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN .�. - ❑ PUMPER TRUCtQYARDICHEM TOa.ETB <br /> TIERLD PERMnTEt)FACILITY ❑ POTELIN 17 LWD US!APPLICATION SnES <br /> O TATTOO186DY PIERCING D On1LR(Pt➢ASE SPECIFY) <br /> MEDICAL WASTE FAC"Tr <br /> 1. Ust up to ten addressesari the space above. Select the types)of riles from the <br /> 209dlist above PY checking <br /> the appropriate boX(es).'A"oast one file type MUST be selected. Fax to( 1 64-01 or matt to the <br /> address Indicated above. <br /> 2, MMi-11,notify the applir,-n if any EIiD files exist An appointment for review will be cOnfUTnOd <br /> approximately rive buslness days but no later than ten(90)days afferrrrecti entsshouOil ld b�tion.scheThu files <br /> will be held for a MXimum of five business days for review. Appo <br /> accordingly. <br /> vely aff being worked an by EHD stmay not be Immediately available for review. A neI <br /> 3. Afile that Is acti , <br /> application may be!vibmitfed when the file u avallaDle. EHD staff at the axpens <br /> 4. Any file not returned In the same condition as released will be reorganized by to reviot <br /> of the applicant Future rii reviews by the same applicant may require a$93.00 desit prior <br /> po <br /> S "TENTATIVE appointment citesff <br /> must be confirmed with EHD sta . <br /> 6, AppIWO!ons fere ved after 3:00 pm wall be Processed the next business day. <br /> CaN�iRl){F i? PF'C3iB0 NT;DATE a 5 TIME <br /> ' A P}fbNE .". FAX' dtrCLtAls§. <br /> ATE <br /> 014 <br /> 1�..';'a . .:. ?' • .. <br /> F3EVtEWVD <br />