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Apr. 26. 2005 2:06PM AD, 'ED GEO ) No. 0333 P. 1 <br /> I 4;61i7 <br /> DATE RECEIVED SAN EHD LOG NUMBER <br /> ENVIT2ONMENTAL AL HEALTH <br /> i4TH COUNTY DEPARTMENT I <br /> 304 E Weber Ave 3d Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 'Web: www.cosan-joaquin.ca.us/thd 2005 APR 26 PH 3; 33 <br /> PUJ LIC RECORDS RELEASE �)APPLIC 7AT/I^ON/' <br /> APPLICANT: w' 7 11 yn.,,�USINESs/AGENCY/JQOUQIICeO Q9& )• t'V � vP 7QNTy <br /> ADDRESS: uJ a S70C 9 ,Sa/l�'S` "HIMEtr7 <br /> PHONE: 2901 !?k7_ 16611 FAC(SIIMIILLFE <br /> ,09- / `��� q�� <br /> TENTATIVE*APPOINTMENT DATE: //e�C2�o r Time: D•�'C <br /> (Please allow 10 husinnees'sYda`ys from date of application - <br /> CHECK BOX TO EXPEDITE REQ ST- 9300 FFE-RE T Pilo ESSED IN 3 BUSINESS DAYS <br /> /SIGNATURE OF APPLICANT DATE / Ol <br /> Department Use Only <br /> U S'r I'dt.J FILE ADDRESS UNIT <br /> of chle-ItlKelp <br /> e <br /> HJT Idw z. s (� S erw E0 an ❑ Unit 1 <br /> S. StRN I, 1� <br /> 4. Sne - 12 ,2 <br /> 6. SOe& <br /> �/ ^� <br /> 7. S,reet �1 <br /> e svae <br /> _ nit 4 <br /> a Weal <br /> 10. Stmt ❑ Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACT _ <br /> OTHER CLEANUP SITE(NON-LOP) EI FOOD FACILITY O SOLID WASTE VEHi REUS <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOMODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE 5PECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking *410 <br /> the appropriate box(es). At least one file type MUST 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 ffles <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 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 reorganized 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 /> 6. "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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS . <br /> REVIEWED YES NO REVIEW DATE <br /> eao a4ZAM <br /> uuxooz <br />