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SFoci,T", <br /> :2J9 99] r_:gEO 11 <br /> _ ""J 11/25/2003 _ 12:13 4640 - ` <br /> u�C���, ,�I�t� ENVIRONMENTAL #TH PAGE 01 <br /> 1 lFbM RECEIVED / L_ :I [nU wv mulvlocr <br /> 1 SAN JOAQUIN COUNTY <br /> NOV 2 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 B Weber Ave 3`d Floor Stockton, CA 95205 6O <br /> cfVVifiiHui;i N iii{2'0�� 468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/ehd <br /> P8 <br /> V FRn41(/SEFVI ,._S <br /> PUBLIC RECORDS FLEASE APPLICATION <br /> APPLICANT; Sq /e " ' BUSINESS/AGENCY: <br /> n�4VLV— � U� � Ur —ToVtADDRESS: / <br /> HONE: Y20/ — FACSIMILE: 10 p— "l O —V <br /> � <br /> ( YJ <br /> TENTATIVE'APPOINTMENT GATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> .SIGNATURE OF APPLICANT DATE <br /> DeOanment Use Only <br /> /� FILE ADDRESS jUni' <br /> i svom 1 <br /> 2. Sind If I <br /> _ lt 2 �011 <br /> it 3 <br /> G '7. SVe l G it 4 <br /> A. 91m+a city nrr <br /> ' 9. Slreel G fd <br /> 10. Slreel G � <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> Z' THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 1�uNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL v.❑ DAIRY <br /> Cl HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH �'C I❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILET <br /> ❑ TATTOO)BODY PIERCING ❑ P OUSPA ��I , .❑��ND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) Lot <br /> 1. List up to ten addresses in the space above. Select the types) of files from the list above by checking <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. END wII( notify the applicant if any END 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 END staff may not be immediately available for review; A no <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 rile reviews by the same applicant may require a$93.00 deposit prior to revile <br /> S. 'TENTATIVE appointment dates must be confirmed with END 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 /> Eno"42-170e <br /> ereltao� <br />