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� �,QO„U&PM Nej Anderson & Assoc. No•4226 t`"P• 2" -- � e SAN J OAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT FEB 17 2004 p 304 E Weber Ave 3rd Floor Stockton, CA 95205 ENVIRONMENT AAZ. A68-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd PERMIT/SERVICES pUBLIC RECORDS RELEASE` APPLICATION 7` APPLICANT: A 12&r -w 9 Q.6BUSINESSIAGENCY: 1 O- A44 v I dh PHONE: 31Ql -31v 1 , FACSIMILE: ; 1o"I - LfZ28 TENTATIVE' APPOINTMENT DATE: 3x2,0 r { Time: vr, (Please allow 10 business days from date of application submittal) 11 CHECK BOX TO EXPEDITE REQUEST - 93=17E REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT AW,//GJ DATE ENVIRONMENTAL HEALTH DEPARTMENT FILES 2ll�f O6+ Department Use Only UNIT ❑ Unit 1 7Unit 2,I '; y) unit3 / nit4 ❑ Unit 5 4 14 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY 1t! OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE Ri UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY 0 HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILET: ❑ TATTGOIBODY PIERCING ❑ POOLISPA - ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) - 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checkil the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The file will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A r application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expel of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to rev 5. `TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE END4ea2-0 6 G6R003 FILE ADDRESS 331 W. Ti"- S}• c i z saes 2-30 Inelvi city Qi i. sA 2 23 vi • 1 &k - 4. saes ?_% t S W - M 6Av� G 5. safe, -1 +o_ Mw IdApek, 6. SA 10(o . ca �+ m ). Safe, .aIS,��4 W • rOl / D . \fI.—CINI e. Strew 33 C'} • — W L.� tIJ 9. 5 sel 1 �F_ II`K0,7AA 5A • �_ " 01y XI M ksA 304 e o G14L Rcn • N 'vau ,0. sv t ENVIRONMENTAL HEALTH DEPARTMENT FILES 2ll�f O6+ Department Use Only UNIT ❑ Unit 1 7Unit 2,I '; y) unit3 / nit4 ❑ Unit 5 4 14 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY 1t! OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE Ri UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY 0 HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILET: ❑ TATTGOIBODY PIERCING ❑ POOLISPA - ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) - 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checkil the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The file will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A r application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expel of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to rev 5. `TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE END4ea2-0 6 G6R003