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Feb 25 04 01 : 13p KRAZAN a RSSOCIRTES 916 564 2222 p. 2 <br /> V 02/06/2004 12:22 4640139 ' ENVIRONMENTAL HEULTH <br /> CfIV tVJ IVi.�� <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT �� I <br /> \�� 304 E Webcr Ave 34 Floor Stockton, CA 95205 <br /> 1 JL�'bv 'g�"20 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/chd <br /> FEB 2 5 2004 PUBLIC RECORDS RELEASE <br /> APPLICATION _ <br /> A "AU(VrA4/AE&(kk/ BU9MESSIAGENCY:, 17 ��GG/ <br /> PFR n�aCES jVS <br /> ADDRESS: C /`�, / <br /> PHONE: /�L� — <` r f 676t FACSIMILE: 91� <br /> TENTATIVE'APPOINTMENT DATE: <br /> [Please allow 10 bualnesc days horn dote of apPKutton _ <br /> e: <br /> -FrR ^r1 <br /> CHECK BOX TO EXPEDITE REQUEST• �REQUFOCE33LD IN 3 BUSINESS DAYS. DATE <br /> SIGNATURE OF APPLICANT _11 DeCartm.onl Use Only <br /> Uni <br /> FILE IF ADDRESS <br /> DDRESS <br /> UNI <br /> T <br /> Unit <br /> FO <br /> U <br /> T. S� <br /> e. men L' ❑ Unit 5 40 <br /> U <br /> 9 9oaM <br /> t7. IL�M — <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> CLEANUP SITE ILS) f�{O HOUSING ABATEMENT SOLID WASTE FACILITY <br /> y�UNOERGRWND TANK NST[ O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON10P) KENNEL ❑ DAIRY <br /> UNDERGRWND TANK(IIIONITORINGRiEMOVAI) ❑ pi CKEN RANCH ❑ PKG TREATMENT PLANT <br /> > HAZARDOUS WASTE GENERATOR O MOTELIHOTEL ❑ PUMPER TRUCK/YAftUICHEMTDILETS <br /> ❑ TlRED PERMUTED FACILITY O POOVSPA ❑ LAND USE APPLICATION SITES <br /> C 7 <br /> ATr001DODY PIERCING ❑ OTHER[PLEASE SPEGFYI <br /> ❑ MEDICAL WASTE FACILITY <br /> y checking <br /> 1. List up to ten addresses in the space above. MUST be select the epecsted f Fax to(209)484 0138 oriles from the list r bma to the <br /> the appropriate box(es). At least one file typo <br /> ffddressindicated above. <br /> 2. EHD will notify the applicant it any EHD files exist An appointment for review*111 be con}Irma <br /> approximately five business days but no later than ten (10)days after reeelpt 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 rile that is actively being worked on by EHD staff may not be immediately available for review. Anew <br /> application may be submitted when the file Is available. <br /> reorganized by EHD staff at the expense <br /> 4. Any rile not returned in the same condition as released will be <br /> of the appllcant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> S. TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:DO pm will be processed the next business day. <br /> TIME <br /> CONFIRMED APPOINTMENT DATE ipfTIALS <br /> DATE CONFIRMED PHONE FAX' <br /> REVIEWED <br /> YES NO REVIEW DATE <br /> Erq u-01U� <br /> rRileel <br />