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119L.2007 13:17 13107982841 PAGE 01 <br /> 46401 ENVIRONMENTAL, , .TH PAGE 02 <br /> S-AN JOAQUTN COUNTY EHD LOG NUMBER <br /> A r! 1 9 2007 ENVIRONMN'1<A LHEALTH DF PARTNmNT <br /> ENVIROsvfv UW fiEA�$ 304 E Weber Ave 3 Floor Stockton, CA.95205 <br /> PER �I1/SER;; 46&3420 Fax: (209)464-0138 Web:w w co.sart joaquin.ca.usle <br /> PUBLIC RECORDS RELEASE A PPLICA11ON <br /> APPLICANT: �� 1 V6f24EIVBi15RPS5SIAGENC7: 6( P —l-t <br /> ADDRESS;;ZS V D!f--cme"t h44) Z�I� / U „ Ute,!1�Ll <br /> PHONE, `�I '�,� � / FACSIMILE., 9' � � 7 � `/�`" <br /> TEPI I ATIYE"APPOINTMENT DATE: Timm:_ 1 , 00 <br /> (Please allow 10 busirwas days from date of application submittal) <br /> In CHECK BOX To EXPEDITE IMaUEST-593.00 FU—REQyFST PWwESSED 1N s BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> QepwVmnt Uso only <br /> MLE ADDEllRESS UNIT <br /> b r -- <br /> z s� 0 Unit 1 <br /> Oki ❑ unit z <br /> sCRYp� <br /> 6. 4pr Unit 3 <br /> Store+ a <br /> X Unit 4 t <br /> s, t Unit S <br /> ENVIItoNMENTAL HMTH DEPARTMENT FILES <br /> �U0 GRoUND TANK(UsT)CLEANUP SITZ;(Lop) 0 HOUSING ABATEMENT ❑��LID WASTE FACIIw[tY <br /> D ER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 2 S0LID WASTE;VEHICLE <br /> —�Nf� RGROUND TANK ONITORINGIPJZMOVAI- 0 TIOG MNNEL ❑ DAIRY <br /> rVNAZARWUS WAM GENERATOR ) D CHICKEN RANCH D PKG TREATMENT PLANT <br /> I3 TIERED PERS MED FACILITY P MOTELINOTEL © PUMPER TRUCKIYARPICHCM TOILETS <br /> n TATT00/130DY PIERCING ❑ POOL/!DPA ❑ LAND USE APPLICATION SITES <br /> a MEDICAL WASTE FACILITY C1 OTHER(PLUSE SPECIFY) <br /> 1. List up to ten addresses In the space above. Select the types) of flies from the list aboyo by checking <br /> the appropriate box(es), At least one file type MUST be selected, Fax.__to(209)4p4.0138 or MIL the <br /> ggdress IndlGated_above. <br /> 2. RHO will notify the applicant if any EHD tiles exist. An appointment for review well be confirmed <br /> approximately five business days but no later than ten(10)days atter receipt of application. The fifes <br /> will be held for a tnaxlmum 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 reviow. A now <br /> application may be submitted when the file Is available. <br /> 4. Any flit not returned In the same condition as released will he reorgani:rad by THD staff at the expam <br /> of the applicant Future,file reviews by the safno applicant may require a$93.00 deposit prior to review. <br /> 5, *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 8 Applications received after 3:00 pm will be proeesaad the nieXt business defy. <br /> CONFIRMED A0P6INTmE=NT bATE _ TIME <br /> DATE CONFIRMED PHONE FAX INITIALS! <br /> REVIEWED YES NO REVIEW DATE <br /> AMP Aa <br /> !/ttQM <br />