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AUG -23-2004 1551 CCOR EARTH TECH <br />DATE RECEIVED — <br />289 532 8773 <br />116 GC' 19 j) SAN JOAQTJ7Di COTNEY <br />ENVJRONMENTAL HEALTH DEPARTMENT <br />pUG 3 2004 304 E Weber Ave 3`' Floor Stockton, CA 95205 <br />2 468-3420 Fax: (209) 464-0138 Web: www,cO.san joaquin.ca-us/ehd <br />ENV�RaMIT SERV C e�� PUBLIC RECORDS RELEASE APPLICATION <br />EHD LOG NUI R <br />jqb07 <br />APPLICANT.I�,atTSy �nN7�� 6U3rNE551Pl;ENCY: IUbbR FAP <br />I4HI <br />Q_a FACSIMILE: _ _ <br />$ 4�14 U <br />TENTATIVE` APPOINTMENT DATE; Time: <br />(Please allow 10 budnc days from data of applleauan submiml) <br />CHECK BOX TO EXPEDITE REVEST - 583,00 --REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE 6 CO <br />Denadment Use Only Arm <br />✓,V <br />✓/ <br />✓✓ <br />U U �� " <br />ENVIRONMENTAL HEALTH DEP NT FILESS'0 <br />UNIT <br />❑ Unit 1 <br />Unit <br />'��DI Unit 3 <br />I& Unit 4 <br />�n ❑ Unit 5 <br />UNDERGROUND TANK (UST) CLEANUP SRE (LOP) <br />M HOUSING ABATEMENT <br />(9 SOLID WASTE FACILITY <br />Or <br />OTHER CLEANUP SITE (NON -LOP) <br />t] FOOD FACILITY <br />SOLID WASTE VEHICLE <br />UNDERGROUND TANK(MONITORINGIREMOVAL) <br />❑ DOG KENNEL <br />0 DAIRY <br />HAZARDOUS WASTE GENERATOR <br />17 CHICKEN RANCH <br />11 PKG TRFATMENT PLANT <br />TIERED PERMITTED FACILITY <br />D MOTEIJHOTEL <br />0 PUMPER TRUCWAItDICHEM TOILETS <br />0 TATTOoIBODY PIEROiNG <br />❑ POOLrSPA <br />K LAND USE APPLICATION SITES <br />NOR <br />0 OTHER (PLEASE SPECIM <br />U U �� " <br />ENVIRONMENTAL HEALTH DEP NT FILESS'0 <br />UNIT <br />❑ Unit 1 <br />Unit <br />'��DI Unit 3 <br />I& Unit 4 <br />�n ❑ Unit 5 <br />UNDERGROUND TANK (UST) CLEANUP SRE (LOP) <br />M HOUSING ABATEMENT <br />(9 SOLID WASTE FACILITY <br />Or <br />OTHER CLEANUP SITE (NON -LOP) <br />t] FOOD FACILITY <br />SOLID WASTE VEHICLE <br />UNDERGROUND TANK(MONITORINGIREMOVAL) <br />❑ DOG KENNEL <br />0 DAIRY <br />HAZARDOUS WASTE GENERATOR <br />17 CHICKEN RANCH <br />11 PKG TRFATMENT PLANT <br />TIERED PERMITTED FACILITY <br />D MOTEIJHOTEL <br />0 PUMPER TRUCWAItDICHEM TOILETS <br />0 TATTOoIBODY PIEROiNG <br />❑ POOLrSPA <br />K LAND USE APPLICATION SITES <br />In MEDICAL WASTE FACILITY <br />0 OTHER (PLEASE SPECIM <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checkin <br />the appropriate box(es). At least one file type MUST be selected. Fax to (209) 4640738 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 files <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 EHD staff may not be immediately available for review. A ne <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 the expens <br />of the applicant. future file reviews by the same applicant may require a $93.00 deposit prior to, revie, <br />5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 3:00 pm will be processed the next business day. <br />APPOINTMENT DATE <br />DATE CONFIRMED <br />TIME <br />PHONE . FAX INITIALS <br />REVIEWED YES NO REVIEW DATE TOTAL P.O: <br />3 G .155y E I oc judo U s t Fie ewe b i? A. <br />