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03/23/2006 14:21 FAX Ia002/002 <br /> 1„i <br /> DATE RECEIVED ern,.,..>:•�.•,:.� . <br /> SAN JOAQuzN COUNTY w <br /> E(,-vi ONmENTAL E EALTH DEPARTMENT Q() <br /> 304 E Weber Ave 3d 'Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209) 464-0138 Web:wtvw.cosan joagain.ca 'ghd.R 23 PH 2 23 <br /> PUBLIC RECORDS RELEASE —FPLICATIQNY �or,vu;ri <br /> ,� EL �� L-� K C.�-'tN{~FLPtR HENT <br /> APPLICANT:�7j,/)'(,�_A.A USiNE551AGENCY: q <br /> ADDRESS: SQ-5y��a�6:`� g� 3.r, S��I.G '^`,�`-( `(.SLI <br /> PHONE: -Z-'09 I ( 10 lsYS FACSIMILE: o <br /> TENTATNE'APPOINTMENT DATE-, `i Aa/() Time: �Wy LL'G �� <br /> �J <br /> (Please allow 10 business days from date of appllption submittal) ,.A a t <br /> MM <br /> E3 CHECK BOX TO EXPEDUE REQUEST•$97.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ DATE <br /> Departrent Use Only <br /> FILE ADDRESS UNIT <br /> see M C1a. r7/ C. <br /> r-1 Unit 1 <br /> (A44 c N F FoK j Unit 2 / <br /> �AL ON <br /> S. 4 9 <br /> G o f Unit 3 //V <br /> Z+. -1 G. Gt. At ic F �J Unit 4 <br /> sred 3 Z� r r r ❑ Una 5 <br /> Ao, Ze 3i?" E;- F Gn <br /> ENVI Fs SC yI 26. <br /> C`,2�� �!'a t5h'r SLfSE¢•+TS RONMENTAL H TH DEPARTMENT FILES <br /> UNOERGRWNO TANK(LIST)CLEANUP SITE(LOP) ❑ ftOUSIHG ABATEMENT S.SOLID WASTE FACit1Y <br /> OTHER CLEANUP SITE(HON•LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 93, UNDERGROUND TANK(MONITORINGIREMOVAL) 13 DOG KENNEL 12tt.DAIRY , <br /> Z HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 19-PKG TREATMENT PIJ,NT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCK/YAA01CHEM TOILETS <br /> ❑ TATTOO1800Y PIERCING O POOtNPA at LAND USE APPLICATION STIES <br /> ❑ MEOICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY)---.-, <br /> 1. List up to ten addr"Zes in the space above. Select the type(s) of riles from the list aboye by checking <br /> - the 'approprlato box(es). At least one File type MUST be selectee!. Fax to (209) 464-0136 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 riles <br /> will be held for air aximum of five business days for review. Appointments should be scheduled <br /> accordingly. l <br /> 3. A rile that is actively being worked on by EHD staff may not be immediately available for review. 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 roorganized 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 review. <br /> S. 'TENTATIVE appointment dates must be confirmod with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next businoss day. <br /> CONFLRMD'PPPQINTFAENT'.ffA7E '_" TIME <br /> ` -% — <br /> r•. <br /> DATEGQNFIRMED PHONE FAX'. .' ;0:.:.-INIT.iALS <br /> FEVIEVIED YFS NO PEVIEhV DATE <br />