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•.•• ..•.y ti LHD Luu Nup1 m <br /> SAN J.,.,QUIN COUNTYPU61-IC HEALTH S1 *VICES � 1 <br /> ENVIRONMENTAL.HEALTH DIVIS10N -)2�.J <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> Fav 15 z000 STOCKTONCA95202 <br /> (209)468--3424 Z D ted b ( 3$ <br /> ENVIRONENT HcALTH PUBLIC RECORDS RELEASE AP IC 100 <br /> PERMIT/SERI <br /> PPLICANT C &rYAD BUS1N$SSIAGENGY_ <br /> PRONEL(U 0&_�, �FAG5IMILF__ —k l C::3s <br /> TENTATIVE'APPOINTMENT DATE �� �� TIME <br /> `� (Pica$*ptva i to 10 byvirig*a days fr*M dAw a}applicaU00 subrrdttal) <br /> L-+ CHECK BOX TO FJCFEaYi E FZECtiES U F 0CES:$F_D IN 3 BUSMESS DAYS <br /> SlGNATIJRE OF APPLICANT DATE �f / <br /> i <br /> PILEADDRESS THIS S1DE EHD STAFF USA ONLY <br /> PX;1C3PAM ELEMEW(S SEARCH <br /> E A 1 4 L 95-3-`7 <br /> C <br /> ENVIR( HEALTH DIVISION FILES <br /> �t NDCRGkOUNi)TANA(Ua-0 CLEANUP SITE(LOP; I] HOUSING ADATtMENT 13 SOLID WASTE FACILrrY <br /> ❑ OTHER CLEANUP$ITE(VON-LDP) In FOOD FACtUTY ❑ SOL ID WASYC VEHICLE <br /> _9L7 t1nU]ERGROUNDTANK(161ONITt7RINWREMOVA�.) ❑ 006 KENNEL In DAIRY <br /> 1_ ►RUOt)S WASTE GENERATOR 0 CHIMN RANCH Q pile TR"TMEW PLANT <br /> 0 TIERW PERMITTED FACIL17Y 0 MOT914HOTLL V PUMPEitTRI r_Kr AR=HEMT0I ETS <br /> C3 TATTOOM00Y PORCINQ CI POOIJSPA - ❑ LAND 116E APPLICATION SITES <br /> 0 MEDICAL WASTE FAf,11_" '❑ PUSLM WATh'K SYSTEM ❑ OTHL■R IPLEASP SPPCiFYA60%Fq <br /> �. <br /> 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(ex). At least one rile type MUST be selected, Fax to{Zqg}464.9138 gr tall t,a the <br /> @ddr2sA indicated above_ <br /> 2. EHO wllf notify the Appficant if any EHD files w4st- An appoinUnent for review will be confirmed <br /> appraxirrlataly flue bUslttess days but no later that:ten(10)days after receipt of application.-The files <br /> will Ise held for a maximurrl of five buslness bays for review. Appointmeltts should be sthodyled <br /> accordingly,, <br /> 3. A Me that iv actively being worked on by EHD Staff may not.be imrrledlately available for rfevicW. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the Same condition as released will be reorganized by EHD staff'at thQ expanse <br /> Of the applicant. Future fila reviews by fhe same applicant may r>aquire a$87,00 deposit prior to revleW. <br /> 5. 'TENTATIVE appointment dates must be conrrrned with END staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> 1 ' <br /> CONFIRMED APPOINTMENT GATE TIME <br /> +GATE CONFIRMED PHONE FAX 1N1•r11J1>,S <br /> REVIEWED YES NO REVIEW DATE <br /> TOTPL. P.01 <br />