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-'-N 06/03/2004 10:24 20946711f AGE STOCKTON 0- PAGE 01/11 <br />DATE RECEIVED El -ID LOG NUMBER <br />SAN JOAQUIN COUNTY <br />n <br />j' •— ` ENVIRONMENTAL HEALTH DEPARTI%IEN'l< <br />( I <br />Ulf V`' l`— u . V 46007 <br />304 E Weber Ave Yd Floor Stocktou, CA 95205 <br />JUN 0 3 20T) 468.3420 Fax: (209) 464-01.38 Web: %mxw.co.san-joaquin.ca.us/ehd <br />1011-60 17 <br />PUBLIC RECOP.DS PELEASE APPLICATION <br />AWf-)- - /� y <br />O� .-y /7 B/U�3(N�,E/SJSIjAGENCY:%rri IIG�f'U tl�f1�./eu/®wrs®e�(� <br />ADDRESS: <br />.+ 23 l 4[/g//QQ <br />PHONE: 4i 7 — / —AM (O FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: P.S . un e <br />(Please allow 10 business days from date of application submittal) ���G ,ted Q Q VI 1 <br />1'c al yam ream.... <br />CHECK SOX TO EXPEDITE REQUES - $9 .00 FEE —REQUEST ROC 1=D IN 3 BUSINESS DAYSJA 2 <br />SIGNATURE OF APPLICANT DATE L7 y <br />�r artrrtent use Oniv <br />FILE ADDRESS UNIT <br />t. 9tmet L� <br />stmt 11 U c [� Unit 1 <br />a, sacet _t 's c Unit 2 <br />4. Street I0 t? to <br />X151 <br />s. street 61A Cl / iI_ le Mynit 3 <br />• 6. Struo! r' <br />7. street 'E . _ _ Pilo—qt ��sC nit 4 <br />Unit 5 <br />to. Stroet Qc - VA <br />' '-j <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND YANK (UST) CLEANUP SITE ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />OT14ER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL C3 DAIRY <br />HAZARDOUS WASTE GENEO GENERATOR ❑ CHICKEN RANCH PKG TREATMENT PLANT <br />TE (LOP) TIERED PERMITTED FACILITY ❑ MOTELIHOTEL Q PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOOA30DY PIERCING ❑ POOL/SPA <J AND USE APFuc;ATIoN SITES <br />❑ MEDICAL WASTE FACILITY Cl OTHER (PLEASE SPECIFY) N491 <br />11List 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. END 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 St the expense <br />of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br />6. *TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 3:00 pm will be processed the next business day. F: - <br />n <br />CONFIRMED APPOINTMENT DATE TIME is <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />EHD -M <br />�/J�� ' Vt� lcu��s �►G(cl� � `.71.i Zdr�i/l�e � r1�Bo�/� <br />