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JAN-26-04 MON 12;20 PM DA LL NELSON SCHRIMP FAX N0, 209-5?6—9320 P. 06 <br /> DATE RECEIVED EHD LOG NUMBER <br /> ��r SAN IOAQUIN.COUNTY . <br /> HECE CEN <br /> \�ED ENVIRONMENTAI,$EALTIllUEPARTMENT <br /> 304 E WDber Ave Std Floor Stockton,CA 95205 / <br /> JAN 2 sM08-3420 Pax: (209)464-01.38 Web;www.co.san-joaquin,ca,us/chd <br /> . "DfJV .0 TfJIEIJI HEALTHPUBLIC RECORW RELEASE APPUCAT10N_ <br /> APPLICANT:_ Kathy L. Monday Damrell, Nelson) Schrimp, <br /> BUSINESSIAGENCY; Pa11105, PanI1Cr & Silva <br /> ADDRESS: 1601 I Street Fifth FloQr, ModestoCalifornia 95354 <br /> PHONE: (209) 526-3500 FACSIMILE; (209) 526-3534 <br /> TENTATIVE'APPOINTMENT DATE: February 10, 2004 Time: 9:30 arm. <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST• 9 IPEE—REQUEST PROCESSED M 3 BUSINESS DAYS 1)�AI 27 <br /> VI <br /> / 2004 <br /> SIGNATURE OF APPLICANT ) ,Vi{ /7�/. � -„i ,.-.+/r^_� DATE January 22,, <br /> 2004 <br /> _ Department Use Only` <br /> FILE ADDRESS UNIT <br /> t. vmm 1601 Turnpike ^--uy Stockton <br /> z. s„nm ,� a., ❑ Unit 1 r <br /> a. 5aeue ❑ Unit 2 n <br /> CAI, Uni <br /> VAMe. si,,,nrn FEBUnit 4 <br /> lo, w�e ❑ Unit 5 <br /> ell <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �R3 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENT D SOLID WASTE FACILITY <br /> THER CLEANUP SITE(NON-LOP) D FOOD FACILRY D SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) D DOG KENNEL D DAIRY <br /> �AZARDOUS WASTE GENERATOR D CHICKEN RANCH PKG TREATMENT PLANT <br /> D TIERED PERMrrTEO FACILrfY ❑ MOTELMOTEL ❑ PUMPER TRUCKfYARDICHE:M TOILETS <br /> 0 TATTOO/BODY PIERCING D POOLISPA D LAND USE APPLICATION SITES <br /> D MEDICAL WASTE FACILITY D 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(20 9)464-0138 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 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 END staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a 893.00 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 /> DATE CONFIRMED PHONE. FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> oranow —'—"”— <br />