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TU 1'eWY4234162 P.02 <br /> VJl-1�—L19101� 11G1HI'I t'KUPI EHD LOG NUMBER <br /> ATE RECENED ---' SAN JOAQUIN COUNTYPUBLIC HEALTH SER ICES ^ <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR I� JUN _ 8 <br /> TKY STOCKTON CA 95202 <br /> - (209) 468-3420 <br /> PUBLIC RECORDS RELEASE. APPLICATIO[� , r (10,�NIENIAL HEALT�H� <br /> (,�, BUSINESS/AGENCY �� <br /> APPLICANT gdS-2 s I <br /> ADDRESS ZcYZS =�-rU� 5� n /`pper 1 <br /> M/�/J 946 - 13(�.J ✓ FACSIMILE Z�' t0 0(0 _ <br /> PHONE ZI./-1 it �r <br /> ' &— 13- 00 TIME ID.�OD !-t <br /> TENTATIVE"APPOINTMENT DATE <br /> (Please Siva 7 to 70 business days frwn dale of appliCadon submittal) <br /> CHECK BOX TO EXPEDITE REQUEST- 8.00 FEE—RE EST P CESSED IN 3 BUSINESS DAYS G <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS gLG <br /> C. a <br /> IS ✓ s+.— CASE - h1ar A� Q <br /> o — it tl t r t <br /> Z k- 5 I) ll Il <br /> II It <br /> o Ste CQ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ,/ <br /> M UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT M`15'01-11)WAS <br /> " THER CLEANUP SITE(NON-LOP) O DAIRY <br /> ❑ FOOD FACILITY O SOLID WAS <br /> DY UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL <br /> M"HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLAN HEM �DO� <br /> ❑ MOTELIHOTEL ❑ PUMPER TRUCWYATION SIM TOIL T <br /> C�IERED PERMITTED FACILITY ❑ OOVSPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOO/BODY PEIRCING �'PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <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 (209) 464-0138 or mail to the <br /> addr"s 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 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 $78.00 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. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> IDATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 0110W00 <br /> TOTAL P.02 <br />