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11/25/2003 16:12 20446711'0 AGE STOCKTON _ PAGE 01/E <br /> DATE RECEIVED EHO LUG NUMBS <br /> SAN JOAN COUNTY <br /> K E C_�9 E L M E 0 ENvjPONmENTAL HFD AUNT <br /> N 0 V 2 5 20 304 E Weber Ave.3rd Floor Stockton, CA 95205 <br /> 109)468-3420 Fax: (209)464-0138 Web:www.co.sanjoaquin.cwas/ehd t <br /> ENVII-ii'JNMENT HEai_I H <br /> -r; .I 111 S E E YJ QE-1 PUBLIC RECORDS RELEASE <br /> J�.APPLICA,�TION <br /> APPLICANT: BU1SINES'SIAGENCY:� �,� �ld V &IU1621J� <br /> ADDRESS: 7 j <br /> r�S r� 8 � <br /> PHONE: OCD 7. /00& FACSIMILE: CX O 6 r /11 <br /> TENTATIVE'APPOINTMENT DATE; 0 � Time: , IlQa` <br /> (Please allow 10 business days from date of application submittal) y `I <br /> CHECK 13oX TO EXPEDITE RL:QU 7.593.00 FEE--RE U T E Ia3,BUVIINESS DAYS <br /> SIGNATURE OF APPLICANT DATE / pt ✓ l/ <br /> Department Use Only <br /> FILE ADDRESS Nrr <br /> 1. Street o <br /> z- Stmet a o rn �- G Unit 1 <br /> street o G I <br /> 4.- sheet <br /> G Unit 2 ._77 <br /> �J <br /> 5. stroer QUnit 3 <br /> r <br /> G. Street <br /> >. street I t cityUnit 4 <br /> 8. Street h G /i <br /> 9. Slnrol C� T nit 5 <br /> 10. Street o <br /> ly <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> F. <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LAP) 0 HOUSING ABATEMENT E3 SOLID WASTE F AL1 ° <br /> OTHER CLEANUP SfTE(NON-LOP) ❑ FOOD FACILITY C3 SOLID WASTE VEHICLE � <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) C3 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/HODY PIERCING . 17 POOUSPA O LAND USE APPLICATION SITES <br /> 0 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 least one file type MUST be selected. Fax to 209)464-0138 or mail to the <br /> address indicated above. <br /> 2. END 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 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 /> 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 /> Tia •' "'� <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DA'Z'E CONFIRMED PHONE FA7C ' INITIALS <br /> REVIEWED ,- YES NO REVIEW DATE <br /> enD 4a.0 --�--- <br /> enrzoos <br />