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TERRRCON - RENO Fax:775-351-2423 Nov 4 2nn- 13:47 P.01 <br /> D �E €I�EQ'� `\\I EHD LOG NUMBER <br /> 1 c-11 �_��- SAN JOAQUIN COUNTY <br /> NOV 0 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3d Floor Stockton,CA 95205 <br /> ,_NVIR0NMERAg0A6h$`3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd I <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICAT•IO' N <br /> APPLICANT: •�TC7 E7 BUSINESWAGENCY: <br /> ADDREss:.1Z 80 6aAF-6 CT # 233 S WKS IJV• 8gVZI <br /> PH ON SI -Z`•FOO FACSIMILE: �l'lS-351'2kZ3 t <br /> CR' o 15 <br /> -- TC^T 1 �C( �1 N•6.7ni <br /> t sn r�uVTMENT DATE: T�fS �aV �a7 Time: <br /> y C f (Please allow 10 business days from date of appllcation submittal) <br /> ate• CHE K BOX TO EXPEOrft` EOUEST•S93.00 FEE—REOUES PROCESSED IN 3 BUSINCSS DAYS <br /> SIGNATURE OF APPLICANT 92n.u) rr DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> t. s�nm Ob S. S 'T, c,ry L0:0 <br /> : 9'teM 10 v.7S i. a DT ❑ Unit 1 <br /> 6. 6boaI 041• <br /> s. sinx 02 WAL_A/J'T" S"T.�) c. It <br /> Uni lr <br /> t ir. sirom G R.C.M S c. <br /> Unit 4 <br /> s. so-e F 4f�N� I C' It v ❑ Unit 5 <br /> to. eime� 01 C,t;NMIAL• PL.JI`t t: <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> L7yNDERCROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT LT,SOLID WASTE F � <br /> PTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE V t: 7 <br /> L•lMDEROROUND TANK(MONITORINGIREMOVAL) 13 DOG KENNEL C3 DAIRY <br /> :f AROOU3 WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKGTREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL Cl PUMPER TRUCxryARD/CHEM TOILETS <br /> M TATTOOIBODY PIERCING l7 POOIJSPA ❑ 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 (202)4frt-0138 or mail to jhe <br /> address Icat bove. <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 new <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 expense <br /> Of the applicant. Future file reviews by the same applicant may require a$83,00 deposit prior to review. <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. t �7 <br /> CONFIRMED APPOINTMENT DATE -1 :3 0 � TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> E°'�°°�td�ll 1 �3 lJo ac{ci ress �r (h 5 f <br /> I7 <br />