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11/07/2003 16:12 9166610430 SECOR PAGE 01/0 <br /> EHE)LV V NUMtstN <br /> DATE RECEIVED <br /> SAN JOAQU]N COUNTY 0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E <br /> iol!�'(�= (�"�' "j/I���n, Weber Ave 3'd Floor Stockton, CA 95205 <br /> I <br /> "='f 20��"4t(8=�i40 Fax: (209)464-0138 Web:www.cosan-joagnin.ca us/ehd ( J <br /> NOV 0 7 2003 PUBLIC RECORDS RELEASE APPLICA'JON <br /> 1 <br /> tld\/IRUN T i BUSINESSIAGENCY:, S£r o2 t.rFud-tPL t< r�A <br /> APPLICApi' ry ` _ <br /> ADDRESS: 3;012 v. E [v s i LOG r^ tK'k' <br /> PHONE: (4ftn) Rtol 4Do X2.F2 _ FACSIMILE: /g,� 5�o1'd y50 <br /> TENTATIVE*APPOINTMENT DATE: If — Time: <br /> (Please allow 10 business days from date of application submittal) 1 .. <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FE5—RST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE /I 1703 <br /> Deoartment use Only 0 <br /> FILE ADDRESSmm'_Ot�c <br /> UNIT <br /> t_ Sbae "q V a ❑ Unit 1 <br /> 2. 5trctl lS t.W \�, \• M I� <br /> 3. SW- v �! V v G PjUnit4 <br /> GI K7t <br /> S. Haeet �� <br /> 5. S�rcN 4 u*!Ca//J ,q:1$(r G � cin .s7rxkTiuF <br /> 3rcn /YZVE G`l�tCL.fAKD/f1 .4K�nL'� GN T <br /> 10. Srcn 0 M_ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> XI�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 04 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Fer HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM 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 (2091464-0133 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 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 nev <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 expensr <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to reviev <br /> 5. *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 INRIALS ; <br /> REVIEWED YES NO REVIEW DATE <br /> tr 4a.az•aaa - <br /> el nwl <br /> Gnpas11 <br />