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Hua. 2/.2VU4 4:4UPM JUN EANIH IUH N0.6355 P. 1 <br />DATE RECEIVED <br />RECIF - SAN JOAQTTIi�I COUP EHD LOG NUMBER <br />,rIC�J ENMONMENTALHEALTHDEPARTMENT <br />304 E Weber Ave 3rd Floor Stockton, CA 95205 <br />AUG 2 i Z0009) 468-3420 Fax; (209) 464-0138 Web: www-co-san-joaquin,ca.us/ehd <br />EnronAlTl MENT7:2 HEALTH PUBLIC RECORDS RELEASE APPLICATION <br />I <br />APPLICANT; lvla -, Lko- &Ae yips gU51NE531gGENCY: / ! %,.. <br />ADDRESS:188 ('yak V ¢, —C • �-5-�� Tf ka-e I'�--< A `y 52o ro <br />PHONE: 2-09— Z34-cisy FACSIMILE: 20 0S; <br />TENTATIVE* APPOINTMENT DATE: /O SQ a er$_ 3o AAA <br />time: <br />(Plaaee allow ie business days from data of application Submittal) <br />CHECK BOX TO EXPEDITE REQUEST -$83.00 FEE— RE LEST PROCESSED IN S BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />DATE 152*O <br />oepa,tme use only <br />UNDERGROUND TANK JUST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT x 1501 <br />OTHER CLEANUP SITE (NON -LOP) ❑FOOD FACILITY ^SOLID WASTE FACILITY <br />1�'UNDERGROUNb TANK (MONrTORINGtREMOVAL) ❑ DOG KENNEL t3]d. SOLID WASTE VEHICLE <br />HAZARDOUS WASTE GENERATOR O DAIRY <br />-TIERED PERMITTED FACILITY CHICKEN RANCH A PKG TREATMENT PLANT <br />❑ TATTOOIBODY PIERCING 0 COUSSPIAOTEL PUMPER TRUCKlYAFtDlCHEM TOILETS <br />O MEDICAL WASTE FACILITY[] OTHER (PLEASE SPECIFY) -- - - - - -0 LAND USE APPLICATION strEs -- - <br />1• List 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 MUST be selected. Fax to (2091484 0138 or mail to the <br />address indicated above. <br />2. END will notify the applicant if any EHD files exist. An appointmentfor reviewwlll 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 new <br />application may be submitted when the file is available. <br />4. Any file not returned in the same conditlon 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 />5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />S. Applications received after 3:00 pm will be processed the next business day. <br />- - <br />JFIRjh' <br />1319 n4uu±son U57 i5 a DA.cctgy <br />FILE ADDRESS <br />UNIT+. <br />z <br />9ueel a <br />s 48 <br />LL /I <br />tlGI S+p4.K <br />VQ <br />s. <br />Sl N 24 <br />G HR <br />U <br />p Unit 1 <br />/—o <br />GI .5 <br />G <br />I <br />✓✓ <br />3. <br />6' <br />Sues f <br />1 <br />G+ 5 fR 9E5 L <br />C�� <br />3°Be° <br />o a G <br />Unit 3 <br />Unit <br />e <br />su�l 90 2 <br />swa 13111 <br />G. 9E5 <br />Unit 4 <br />c G 5 <br />S. <br />sues <br />ti <br />o. <br />M <br />; e- a 1� <br />O Unit 5 <br />ENVIRONMENTAL HEALTH DEPARTMENT FiL '9 'Znv <br />//1I� <br />�It,A� <br />r_ <br />P <br />UNDERGROUND TANK JUST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT x 1501 <br />OTHER CLEANUP SITE (NON -LOP) ❑FOOD FACILITY ^SOLID WASTE FACILITY <br />1�'UNDERGROUNb TANK (MONrTORINGtREMOVAL) ❑ DOG KENNEL t3]d. SOLID WASTE VEHICLE <br />HAZARDOUS WASTE GENERATOR O DAIRY <br />-TIERED PERMITTED FACILITY CHICKEN RANCH A PKG TREATMENT PLANT <br />❑ TATTOOIBODY PIERCING 0 COUSSPIAOTEL PUMPER TRUCKlYAFtDlCHEM TOILETS <br />O MEDICAL WASTE FACILITY[] OTHER (PLEASE SPECIFY) -- - - - - -0 LAND USE APPLICATION strEs -- - <br />1• List 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 MUST be selected. Fax to (2091484 0138 or mail to the <br />address indicated above. <br />2. END will notify the applicant if any EHD files exist. An appointmentfor reviewwlll 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 new <br />application may be submitted when the file is available. <br />4. Any file not returned in the same conditlon 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 />5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />S. Applications received after 3:00 pm will be processed the next business day. <br />- - <br />JFIRjh' <br />1319 n4uu±son U57 i5 a DA.cctgy <br />