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11/01/2004 12:10 FAX 209 9480-1 002/002 <br /> lyap <br /> 19 r�� LSI!, On SAN JOAQUIN COUNTY "` <br /> ENVIRONNIENTAL REALTQ DEPAPTNIENT D4 <br /> NOV - 1 2004 304 E Weber Ave 3`d F1ooc Stockton, CA 95205 <br /> (209) 46$-3420 Fax: (209)464-0139 Web:v(-,vw,co.san-joaquin.ci us/ehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS PEZ,EASE AYPLICATION <br /> ApPUCANT;�.rr_... r �j,� BUSINESSIAGENCY: /Jlelrrtr <br /> ADDRESS_ d su, <br /> PHONE: IIIA/ 9L[7�— � F� - FACSIMILE. GTJX <br /> TENTATIYI APPOINTMENT DATE: P tro jo`I Time: <br /> (Please alloy 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 7 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �� ��►"��^--' <br /> DATE <br /> peoartment Use Only <br /> FILE ADDRESS UNIT <br /> i. see '4 LA a!y )11,7- <br /> ;59- <br /> 1 zo7- T .0ty '9"a-br, <br /> alvi a '54044-fo. �> Unit \C1 <br /> s sr a Unit 3 <br /> 6. SUM G <br /> Unit 4 <br /> �. sveet <br /> a. sMce <br /> 9 Sleet G Unit 5 <br /> IA. Sble G <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP 5rrE(LOP) ❑ HOUSING ABATEMENT 14,SOLID WASTE FACILFTY <br /> OTHER CLEANUP Srrr-(NON-LOP) ❑ FOOD FACILnY ❑ SOLID WASTE VEHICLE <br /> a UNDERGROUND TANK(MONTTORINGIREMOVAL) ❑ DOG KENNEL IEL DAIRY <br /> X HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH E--PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILnY Q MOTE:LA4OTEL ❑ PUMPER TRUCKIYARDICHEMTOILF'TS <br /> ID TATTOOIMODY PIERCING Q POOLISPA I& LAND USE APPLICATION SITES <br /> ❑ MEDICAL.WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the 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 /> 2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> HD staff may not be immediately available for review. A Herr <br /> 3. A file that Is actively being worked on by E <br /> application may be submitted when the file is available. <br /> 4. Arty file 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 revieA <br /> 5, *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> - •:E%,,.+ �- .. IME ' �'���' -`�{'�' ;:�P.;.•`� <br /> RM P. <br /> APPOINTMENT�ATE �, ,_' -:�:_ -T <br /> ' INF-r.IALS <br /> F. <br /> 1.'.'DAT. COIJFIR1VfED PHONE <br /> REVIE)NED = YES 'NO REVIEW DATE, <br /> ' EHD 1H-02-0a6 <br /> 61E200] <br />