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\ , /: iG . U` :39 i,AX 41595)041 'CRLAU61LL1. & ROLLU I&OUI <br /> V 11/19/2003 14:49 4640138 ENVIRONMENTAL HEALTH PAGE 02 <br /> DATC RECEIVED • 464013e • EHU LUG NUMULF <br /> I ; JAN JOAQUIN COUNTY <br /> R <br /> Lc_r� , / Ir 'it i' E+ N,'IRONMENTAL HEALTH DEPARTMENT <br /> 304 E Wcbcr Avc 3rd Floor Stockton, CA 95205 <br /> NOV 2 0 2003 <br /> (209) 463-3420 Fix: (209) 464-0138 Web: www,co.san-joaquin.ca.us/ehd <br /> ENVIRGNMEri I iittiLi t / <br /> PERMIT/SERVICES !r (PUBLIC RECORDS RELEASE APPLICATION <br /> I <br /> APPLICANT: �G'L1�." ✓t'�V"1W1°WBUSINEESSIAGENCY: 1VBLf((u <br /> Mood <br /> L} 4 D <br /> ADDRESS: __.SSS /V`ood Gd ,f "S-f• d�f�' • I SO6 LG (� <br /> PHONE: LITS ��� qr�L( (] I FACSIMILE: L115 -5 J <br /> TENTATIVE*APPOINTMENT DATE: �I Z 603 Time: <br /> I� <br /> (� <br /> (Please allow 14 business days from dale of gppliCation submittal) <br /> C9 CHECK BOX TO EXPEDITE REQUEST-599}.00FEE— ..QUEST PROCESSED,1N a BUS INESS DAYS <br /> SIGNATURE OF.APPLICANT . ,DATE. / V <br /> Department Use ONv <br /> FILE AD Rf'S$ UNIT <br /> s 11, Z city <br /> ❑ Unit 1 <br /> x. 511 \ ..ety <br /> .,.. .. { <br /> 9. Street V M avl I Z <br /> 1 s,mel ell �Li� <br /> Unit 3 <br /> e. 51111, - 4 <br /> +. 511et, Unit 4 <br /> e. Ssu, <br /> CITY ,GY rn^ <br /> 9. same, C" ❑ Unit 5 <br /> W, L"11 0, Ism a mom III <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> YH UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 17 SOLID WASTE FACILITY: ;... <br /> Ja"'r OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY - ❑ SOLID WASTE VEHICLE <br /> �(UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY ' <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YAROICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOUSPA ❑ 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 (209)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 EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a,$93.00 deposit prior to rev w. <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 /> eHo+e•a:•uoc <br /> e,uxoas <br />