Laserfiche WebLink
08/13/04 07:49 FAX <br />vets/ UJ/ 2ee4 14: !J4 464617 - <br />ENVIRONMENTAL N" TH <br />�lWIED SAN JOAQunv COUNTY <br />J <br />WIED <br />NVMONMNTAL HEALTH DEPARTMENT <br />AUG 1 3 2004 304 E Weber Ave S-4 Floor Stockton, CA 95205 <br />4209)E�f� 8420 FAX'. (209) 464-0138 Web* WWW.co.San joagUin.ca.US/ehd <br />� ji\v'okJNME H <br />2001 <br />PAGE 01 <br />EHD LOG NU B <br />�+ ,1;,�IiISERVICES PUBLIC RECORDS RELEASE APPLICA.UON <br />APPLICANT: �'� — _ BUSINE331AGEN": <br />ADDRESS., 1,!5-17 $oc!LL:fta wa Sup A <br />PHONE: {4 b g� FACSIMIMQr� rOQQ-� S <br />us, -Q `f <br />TENTATIVE APPOINTMENT DATE: �f �t8, Z `= - Time: Q- ao AM- <br />(Pleaso allow 10 business days from date Of application submittal) <br />0 CHECK BOX TO EXPEDITE REgl1E � S93A0 FEE -REQUEST c�cE SED IN 3 BUSINESS DAYS gLI <br />4 <br />SIGNATURE OF APPLICANT a �_ DATE <br />DeGartment use Only <br />❑ Unit 1 <br />❑ Unit 2 <br />❑ Unit 3 <br />000 Unit 4 <br />❑ Unit 5 <br />EWRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOQ) <br />O HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />E2 SOLID WASTE VEHICLE <br />U OTHER CLEAN SITE (NON -LOP) <br />0 TANK (MONITORINGIREMOVAL) <br />d FOOD pACILtTY <br />la DOG KENNEL <br />CJ DAIRY <br />a PKG TREATMENT PLANT" <br />UNDERGROUND <br />❑ HA'ZpaUpUS WASTE GENERATOR <br />p CHICKEN RANCN <br />O ctuCKENMOTELfHRAN <br />C3 PUMPt"R TRUrK/YARD/CHEM TOILETS <br />❑ TIERED PERMITTED FACaM <br />CI POOLISPA <br />O LAND USE APPLICATION sfrEs <br />❑ -TATTOOIBODY PIERCING <br />p OTHER (PLEASE 5pEC ) <br />CI MEDICAL WASTE FACILITY <br />b checking <br />1, Llst up to tett addresses in the space above. MUSTelecttbe selected f pax tfileso249 4164-0138 or ma151. ll to the <br />the appropriate box(es). At least one file typ <br />address indicated abov . <br />�, �Hn will notify the applicant if any EHO files exist. An appointment for review will be confirms <br />approximat®ly five business days but no Mer than ten (10) clays after receipt of sppllcatlon. The files <br />will be held for a maximum of five business days for review. Appointraerib should be scheduled <br />pccordingly. <br />3. A file that is actively being worked on by EHD staff may not be immediately available for review. A nev <br />application may be submitted when the file is available. <br />4, Any file rto# returned in the sante condition as released will be reorganized by EHD staff at the expense <br />of the applicant. Future file reviews by the same applicant nmay require a $93.00 deposit prior to reviev <br />S. *TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 3:00 p1n will e processed the next business day. <br />C0N 21RMED APPOINTMENT DATE <br />DATE CONFIRMED PHONE: <br />^�1 <br />REVIEW DATE <br />RtVIEWED YES NO <br />9Z 48-02-006 1 ' <br />/j/7 ��1 0! i <br />TIME <br />FAX.* 1H177A1,S <br />f1415 - <br />J <br />