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OATE RECEIVED FHD LOG NUMBER <br /> ily SAN JOAQUIN COUNTY wt/ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3r"Floor Stockton, CA 95205 / <br /> (209)468-3420 Fax: (209) 464-0138 Web: www.co.san joaquin.ca, e / <br /> "611 <br /> /���,1� � (('� PUBLIC RECORDS RCI APPLICATION GGG�.....���_ 1 <br /> APPLICANT: ��yy (,.c.p BUSINESSIAnGFNCY: , r f(/1-� ^t- • L}U-C . <br /> ADDRESS: }�-y�2 tl� r�v�,_G76 q EX4 Q' <br /> PHONE:_ ,7l_k� ' 5959-Li \ FACSIMILE: too ``-rzzk <br /> TENTATIVE*APPOINTMENT DATE: I 'A-I-2-J 1)-,1"` Time, <br /> (Please allow 10 business days from date of application I <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCES U - DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 2 oI {or. <br /> ''••2. sima Z11—te E. 1_6uawu o A ID c1 ,t �/ ❑ Unit 1 <br /> rt�t 2 SZJ ^s 1 Com• 3 ' ofS C7 Unit2 <br /> so-ml 5t f 0 1 Unit <br /> slmni 224c0 4-tin.a.. *� Ylo <br /> 0.\n ur! tftt kwZ os.- 94 • 6 I t UCS sI <br /> �\ slrcN 2-5-+3 rS,, P- .. lI - of 146Unit4 <br /> 21 fro M zoic. P-� . 6 <br /> , . o-eN '2�{ YYIAr� oda I I ❑ Unit 5 <br /> 1• 3rnlo3 Ye�4�svw. f} <br /> ENVIRONMENT L H I TH DEPAR t NT IL <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> W OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 10 UNDERGROUND TANK(MONITORINGIREMOVAL)V ❑ DOG KENNEL ❑ DAIRY <br /> 81 HAZARDOUS WASTE GENERATOR" ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY✓• noAO ❑ MOTEIJHOTEL O PUMPER TRUCK/YARotcHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING L1 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 EMD staff at the expense <br /> of the applicant. Future file reviews by the salve applicant may require a $93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with END 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 /> ENO".02;an6 — <br /> elarton� <br />