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fl, LtD LOG NUMDEID SAN JOAQUIN COUN'CY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Nu f 2 0 2007 304 E Weber Ave 3r6 door Stockton, CA 95205 <br /> FWf1RONMENT , W) 468-3420 Fax: (209) 464-0138 Web: w-ww.co.san-joaquin.ca. s, h;2 ()fo <br /> PFIKTi T/SWI C <br /> PUBLIC RECORDS RELEASE <br /> f APPLICATION <br /> APPLICANT: A-bb F`� C.C_Z> - BUSINESSIAGENCY: A Pit 1 ©, A r1& f ,r (t"C <br /> ADDRESS: qD �ID��S �� <br /> PHONE: 3VT ^ ✓- 1 FACSIMII.I;: CEJ l� -2 1 O <br /> TENTATIVE"APPOINTMENT DATE: �1 ( �`a I D!} Time: 1 Q <br /> ' <br /> CFO <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT —�� � dATE I ZDF 0 <br /> Department USa Only <br /> FILE ADDRESS UNIT <br /> t, street ❑ Unit 1 <br /> 2. sly C4 c cily 39"31 <br /> 9. set 3932- N( � l-^. city [] Unit 2 <br /> 4. Stre 3 I U r i Q'c� ` car\ C41 <br /> ' <br /> 5. street 3J V • 9A 1'� Clt Unit 3 <br /> F,, Slrecl 14 1 D 9 t� JS 6) <br /> 7. sheet �- N• 'v Q•� )� , ^`� 1 CI' Unit 4 <br /> A, Street xi d �/� '' City <br /> 9. SlrCrl 3 U l ° �rrl'I-C-c aw: cl _ Unit 5 <br /> CII < <br /> ENVIRONMENTAL HEALTH DEPARTMEN <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT C7 SOLID WAST .._ <br /> OTHER CLEANUP SITE(NON-LOP) ED FOOD FACILITY d SOLID WASTE V CL7 <br /> UNDERGROUND TANK(MONITORINGfREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATORX 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITYt 0 MOTEL/HOTEL L] PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING Cl POOUSPA 0 LAND USE APPLICATION 5ITES <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 1. Dist 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 MAST 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 file <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHE) staff may not be immediately available for review. A <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 END staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EMD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CCINFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> --if-14D 40-02-009 - <br /> (1/8r200J <br />