Laserfiche WebLink
11/07/2003 16:12 . 916861043n SECOR - PAGE 01/0 <br /> DATE RECEIVED 10 <br /> EHO LUU NUMUeu <br /> SAN JoaQuIN COUNTY <br /> ENVIRONMENTAL HEALTR DEPARTMENT <br /> 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> 1=If <br /> 1209 468>Q4�L0 Fax: (209)464-0138 Web:vnvw.cosan-joaquin.caus/ehd I <br /> NOV 0 7 2003 PUBLIC RECORDS RELEASE APPLICA'T'ION <br /> ri?UII 1 y ed n <br /> APPLICAtIjPT� 1 T��j BUSINESSIAGENCY: <br /> ADDRESS: —r w +rcE Pn s Y-.��c•b C�mJ� .CA _9,Q7r2 - <br /> PHONE:C91(,) etok"6_4m xZR3 _ FACSIMILE: knl^dy_ — - <br /> TENTATIVE'APPOINTMENT DATE: Time: )O:m Av <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.0 RST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT i DATE. f//7/0-S <br /> Department use Only <br /> FILE ADDRESS UNIT <br /> s,ei a a ❑ <br /> Unit 1 <br /> 2. slrcN di <br /> 7 <br /> 3. street o �^� ❑ Unit 11-�� v� <br /> 4, Sv't .I City s arc <br /> s. aiaet `/`b :re a K b 113 <br /> s. sirc� w Ue1Cq/N Air an .nszKZdEI j" <br /> r. 3ireat 14ZG E. ci ♦UH i,)nit 4 <br /> ON <br /> -5 Tbc <br /> s. slroH ui nit 5 <br /> 10. Slrcel G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 04 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY Cl SOLID WASTE VEHICLE <br /> YL UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> FT HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL 13 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY I7 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 mal to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD flies 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 nev <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 expensf <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to reviev <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 /> EH 4042400 , <br /> BM/2003 <br /> i✓.. .I- . KrK Gnresil <br />