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Jun. 2. 2005 2:57PM A' 'NCED GEO N0. 0633 P. 1 <br /> DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> �7 S ? v ENviRONMENTAL TlEA TH DEPARTMENT <br /> 304 E Weber Ave 3r°Floor Stockton, CA 95205 ,° <br /> SH <br /> JUN 0 2 20�I)468-3420 Fax: (209)464-0138 Web:www.co,san-joaquin.ca.us/ohd <br /> ENVIRONMENT HERLTH p LTC RECORDS RELEASE,/APPLICATION/� �o/L <br /> APPLICANT; W q y�,,�USINESSIAGENCY: a Ua�m e d �VT UIIbIJ(,�'je/1 ILL.L <br /> ADDRESS:- 3�} ryu) Sl Vc OA /J4 /'7�5+ <br /> PHONE; /]l,0 - yh / ` I©Oz FACSIMILE: O 7r.�'A,7T/ / ` � ,Q./f 11 <br /> TENTATIVE'APPOINTMENT DATE: w OS `W�u Time: � A �U 1 1 <br /> (Please I PP <br /> in Trbm�oi V13BUSINESS <br /> len suhmiUaqCHECK BOX TO EXPEDITE REO ST• 93.0RE U 7 PRO ESD DAYS <br /> SIGNATURE OF APPLICANT DATE a <br /> Daparlmert Use Oniv <br /> j*f � FILE ADDRESS . UNIT !!! <br /> DDI J Ltarea L �fi El Unit 1 <br /> 61,!01PAPPar—K L#421 9 Z y <br /> a swe M El Unit 2 <br /> �IF �. se.a W 8 <br /> rJlr s.n � Unit 3 <br /> \�/h NvJ e. Sex _.. <br /> �a ST T. seee OU/$ nit <br /> �U <br /> sre. sn>el U eco4T <br /> Ftp ksr SI e, swa tA !V/l Units <br /> rJlf ,a. s— 2320 _E OW601 1 a C _ M <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 200 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT d SOLID WASTE FACILITY _ <br /> OTHER CLEANUP SITE(MON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK GENERATOR <br /> (REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR d CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKIYAROMEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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(2091464-0188 or mail to the <br /> address indicated above. CD <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately rive 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 some 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 /> 5. `TENTATIVE appointment dates must he confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm Will be processed the next business day. <br /> CONF)RM,ED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ENb�p-0Z-0OB <br /> L&3(101 <br />