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11/07/2003 16:12 9168610420 SECOR PAGE 01/0 - <br /> EHU LVl>NUMHtIf <br /> DATE RECEIVED 6 SAN JOAQUIN COtrNTY <br /> * ENVIRONMENTAL HEALTH DEPARTMENT <br /> RIR <br /> /L,-< I,_ I;48- 140 <br /> r 304 E Weber Ave 3'd Floor Stockton, CA 95205 h(/� <br /> 120�Y A�8 b40 Fax: (209)464-0138 Web:wwW.co.san-joaquin.cans/ehd I <br /> NOV 0 7 2003 PUBLIC RECORDS RELEASE APPLICA'T'ION <br /> LIVE`/ill(JN� 1 BUSINESS/AGENCY: 5'cr oR i,rERdhp/ raC�ery�A.t7EA <br /> APPLICA{j <br /> ADDRESS: " E � <br /> PHONE: cin' $(ot Z '3 FACSIMILE: tc71- 14{} gpi—oy50 <br /> TENTATIVE"APPOINTMENT DATE: I f Time: /u m A" <br /> �t�ll (Please allow 10 buslnass days from date of application submittal) <br /> L-J CHECK BOX TO EXPEDITE REQUEST-$93.00 FE —REQ' ST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT - DATE u/7A <br /> Department Use ONY <br /> FILE ADDRESS UNIT <br /> a a ❑ Unit 1 <br /> ,. Sireal <br /> ILI� (�J <br /> 3. 9veet G �� [I unit 2 II <br /> 5. fiveet �/fib :TE ui K'rro It 3 llU'J"L <br /> 6, Street 4 LlJCo/N Air ��� ����� NH <br /> r. svem 07L, E G rl Unit 4 <br /> s. seen <br /> p, nit 5 <br /> 10. Slrcet <br /> a <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> R�'UNOERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> 7 OTHER CLEANUP SITE(NON-LOP) Cl FOOD FACILITY O SOLID WASTE VEHICLE <br /> A UNDERGROUND TANK(MONITORINGIREM OVAL) 17 DOG KENNEL ❑ DAIRY <br /> GS HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ M EDICAL 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) 464-0136 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 nee <br /> ap y ication may be submitted when the file is available. g EHD staff at the experts' <br /> 4. An file not returned in the same conditlon as released wilantl be may or ulna ed 3A0 deposit prior to nevi <br /> of the applicant. Future file reviews by the same app y Q <br /> ev <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 /> n+o aeaz.00a <br /> ere/xoaa <br />