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09/13/2SSP 13N4gM <br /> :53FA1121D4 <br /> 1C0.`O) ENGINEERING <br /> 2002/002 <br /> DATE RECEIVED P.1/1 <br /> SAN JOAQUIN COUNTY END LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3"1 Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209) 464-0138 Web; www-cO.san joaquin-ca,us/ehd <br /> PUBLIC RECORDS RELEASEAPPLICATION <br /> APPLICANT: BUSINESS/AGENCY. •f <br /> ADDRESS: ZZb <br /> PHONE: ^r� <br /> FACSIMILE:_�(nQ� C�7� Q•'f�j <br /> TENTATIVE'APPOINTMENT DATE: <br /> fros <br /> tlme- <br /> - <br /> (Pleage arrow 10 business daY m : <br /> date°r appliCa6°n rubmittat) <br /> © CHECK BOX 79 EXPEDITE REQUEST-$93.00F -R QI TPROCESS I HU31N655 DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Department Use Only <br /> Flee ADDRESS , <br /> Stra„ <br /> °ea47s,.,., ssq9SBasvneR1�wnonaeeoaseaBoli I l <br /> 1' ��S anCGcCI <br /> nl <br /> I" <br /> NIT <br /> ❑ Un <br /> it <br /> it2 <br /> 101U n <br /> cUnit 4 <br /> 10 aue,i <br /> a� <br /> OUnitS <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGRONU TANK(UST)CLEAN up SITE(Lqp) <br /> M UNDER CLEANUP SITE(NON-LOP) ❑ HOUSING ABATEMENT ❑ <br /> ❑ FOOD FACILITY ,SOLID WASTE FACILITY <br /> VNDERGROUND TANK(MONrrORINGIREMOVAL) 0 DOG KENNEL = SOLIb WASTE VEHrCLE <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH C DAIRY <br /> Cl TIERED PERMITTED FACILITY MO7ELlHOTEL O PKG TREATMENT PLANT <br /> C MEDICAL ODYWAS PIERCING d PUMPER TRUCK[yARDlCHEM TOILETS <br /> O MEDICAL WASTE FACILITY ❑ OTHER <br /> (P 4 LAND USE APPLICATION SITES <br /> ❑ OTHER(PLEASE SPECiF1� <br /> �• List up to ten addresses in the space above. Select the type(s)of files from the list above by cheCRing <br /> the appropriate box(es). At least one file type MUST be Selected, Fax to(209)464.09 <br /> address Indicated above. .38 Or mail to the <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. App <br /> accordingly. ointments should be scheduled <br /> 3, A file that is actively being worked on by EHD staff may net be Immediately available for review- A new <br /> alr`002tlon may be submitted when the file is available, <br /> 4. Any file not returned In the same condition as released will be reerganixed 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 procesaed the next business day, <br /> CONFIRMED APPOINTMENT DATE <br /> DATE CONFIRMED Pest-itm Fax Note 7671 pate / or <br /> REVIEWED I� 04 pages 1 <br /> YES NO TO 17O V NGr.CCj <br /> rueaow 2ZN5 Co,/bapL <br /> Cu. C Q <br /> Phone Phone <br /> 8 78 7 <br /> 99.8 -06 I f°"x �i37-�77 <br /> 09/13/2004 19ON 11:16 [TX/RX NO 7273] Q001 <br />