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Auz-09-04 21:43 From-TTI TETI -CH EM INC +9168520307 T-017 P.01/02 F-227 <br /> EhP LOG NUMBER <br /> DATE RECEIVED (� SAN JOAQUIN COUNTY <br /> I L '`1 '����'YF�J NYIRON YI NTAJ H ALTki DFPAIZTMF T <br /> 304 E Weber Ave 3"'Floor Stockton,CA 9520 <br /> AUG 1 0 2.004(209) 469-3420 Fax: (209)464-0138 Web: www.co.s=-joaquir ca.us/ehd jLlb <br /> E-Mi�:,jiWENT HEALTH <br /> PE PUBLIC RECORDS RELEASE APPLICA FION <br /> APPLICANT' `-1 �1 �-� BUSINESS/AGENCY. <br /> ADDRESS: 1 LCk # in NcAc? c,,c,(Q nv C <br /> PHONE: qFACSIMia: ` iii1 52' <br /> 050 -4 <br /> TENTATIVE-APPOINTMENT DATE: 2,4-) y LO Tlmv] <br /> �ry (Please allow 1A uusiness days frosupmi al) <br /> I—I CHECK BOX TO EXPEUITF RERUI=ST-$93-00 FEE-REQuESTNFSS D YS <br /> SIGNATURE OF APPLICANT PATE d a <br /> Deparu t use only <br /> FII-EADDRESS UNIT <br /> 2.2 2- E. e 1s.14 c.. �T'o C El unit 1 <br /> 2. sueac 7 '9- M A 1 <br /> 3 Sung -3 E . c= ❑ Unit 2 �Q v <br /> 4 Suvot 1- C• C <br /> 5 Soenl Y H Gn <br /> x CA <br /> 7- Cxy 6 <br /> 5„oar 2 S 772 35 <br /> a s 2.0 S. 4--1ANC01-Aj c.; 1 <br /> A4GGi4` L-0- cA. m 35 / 4eQ)nit 5 <br /> 10. Stteac f,9,3 C 7Q GY, 3 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE <br /> UNDERGROUND TANK(uST)CLEANUP SITE(LOP) ❑ HouS(NG A5ATEMENT Q SO ID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY Q SO ID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINCaREMOVAL) ❑ DOG KENNEL M DA RY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH C1 PK i TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY M MOTEUHOTEL C3 Pu PER TRUCK/YARAfCHEM TOILETS <br /> M TATTOQ/HOPY PIERCING M POQuSPA 0 LA iP USE APPLICATION SITES <br /> M MEDICAL WASTE FACILITY a OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type-0)of files f om the list above by checking <br /> the appropriate box(es)- At least one file type MUST be selected. Fax t 209 4640138 or mail to the <br /> address indicated above. <br /> 2. EHP will notify the applicant if any EHD files exist. An appointment for 1 eview will be confirmed <br /> approximately five business days but no later than ten(10)days after re ceipt of application. The files <br /> will be held for a maximum of five business days for review- Appointmt nts should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immedia ely available for review. A new <br /> application may be submitted when the file is available. <br /> 4_ Any file not resumed in the same condition as released will be reOrgan d by FHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require 1$93.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3;00 pm will be processed the next busines day. <br /> CONFIRMF-D APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> RFVIFWEP YES NO RF-VIEW PATE ` <br /> Eno aB-0Z-0u6 <br /> &WZ007 <br /> f <br />