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TERRRCON - RENO Fax:775-351-2423 Nov 4 2 13:47 P.01 <br /> SAN JOAQUIN COUNTY <br /> .EHD LOG NUMBER <br /> NOV 0 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304E Weber Ave 3`d Floor Stockton, n j 95205 <br /> ENVIRUNMEp,Jf2rQ��,�t$-3420 Fax: (209)464-0138 Web: www.cosan-joaquin.ca.us/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 7 E me c BUSINESWAGENCY: <br /> ADDRESS:1 3 80 6pis <br /> PHON 5'I^2.�f00 FACSIMILE: lI7S '3S "2VZ3 <br /> cat.Q '71r-7.50- <br /> TMENT DATE: NCrV IIJ Time: <br /> /(/, ( (Please allow 10 business day%from data of application submlhal) <br /> rel/ `1 Q" I'X2=QD9) <br /> I'L�� CHECcK BOX TO EXPED EOUEST•$93,00 FEE—REQUE9 PROCESSED IN 3 BUSINESS GAYS <br /> SIGNATURE OF APPLICANTQ/�U) •r DATE <br /> v <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> alba 00 S. S f. C; L 0:0 <br /> even JQ V3 S"T. C �'= Q Unit 1 <br /> i <br /> City <br /> 8. 91m sem( CI 1� <br /> 6. Beoc 5 S"T. <br /> 2 WAL <br /> s. slmx orJJT 'T.� c+- Q <br /> SIt � <br /> s. X Ply I CK Uni <br /> slrocl C Iz 5 u ` ` <br /> s, street O7 v., Unit 4 <br /> 4v <br /> B. sf t�'�tJv I Ci II I. \,� <br /> ,o_ 612ec Dt c,c-tr-caatt^ PL.JI`t is 11 Unit s y <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES n <br /> n<DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT EI'SOLID WASTE F <br /> HER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY Cl SOLID WASTE f tfrk IJ <br /> 1ir10ER6ROUNO TANK(MONRORINOIREMOYAL) ❑ DOG KENNEL O DAIRY Zo, <br /> E� OOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> in TIERED PERMITTED FACILITY O MOTEL/HOTEL ❑ PUMPER TRUCKryARDfCHEM TOILETS <br /> Ell� MEDICALTATTOOiWASOoY PIERCING t7 POOLISPA ❑ 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)east one file type MUST be selected. Fax to(2091 464.0138 or mail t0 the <br /> address Imdicated above <br /> Z. END will notify the applicant if any EHD tiles 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 review. <br /> 6, <br /> Applications recedived after3pointment t00 pm Wies must ll be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> crib er.aaaas <br /> Dr Ch wcc�i� f (urs �io5sta Yssrs17S� �&J7sf <br />