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09/13/2004 11:53 FAX 209 948(��� 11002/002 <br /> SEP 13 104 11:19gM Ct3MMUl) ENGINEERING <br /> P.1i1 <br /> DATE RECENED <br /> SAN JOA QIoIN'COUNTY EHD Loo Num®ER <br /> ENVIRONiMENTAL HEAL-T$DEPARTMENT <br /> 304 E'Weber Ave 3N Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web;WWW.co.san-joaquinca,us/chd <br /> FUBLIC RECORBS RELEASE APPLICATION <br /> APPLIa311Irr: BUSINESSlA6ENC7 <br /> Ml — 4L <br /> ADDRESS: <br /> PHONE: 7 FACSIMILE: <br /> 77 <br /> TENTATIVE"APPorNyvEMT DAm- Thne: <br /> (Phase alrow 10 t1winasa days from date ot■pptrcetion tvbmMal) <br /> MiRCKBOxToExpzorrLFREOUMT.$93.00Fr–RE oROC l SUBINESS DAYS <br /> SIGNATURE OF APPLICANT DATE q f <br /> 060"ent use 0* <br /> FILE ADORES UNIT <br /> Ch.a srmi ❑ Unit 1 <br /> two <br /> �. a [3 Unit 2 <br /> 6. ■ <br /> ❑ Unit 3 <br /> s, a <br /> e. D <br /> C3. Unit 4 <br /> ❑ Unit s <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> p 11NDERGRO1010 TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATSMENT 0.SoLi0 WASTE FAciLnrY <br /> C OTHM CUMUP SITE(NON•LOP) O FOOD FACILITY t7 SOLID WAWE VEHICLE <br /> Q UNIM MOUND TANK(MONI TORNGIREMOVAL) O DOG XMEL E DAIRY <br /> O HAZARDOUS WASTE GENERATOR ❑ CHIC!(itri RANCH C3.PKG TREATMENT PLANT <br /> C3 111M P111RMT1>ED FACILITY Q MOTELMOTEL d PUMPER TRUCKWARDICHEMI TOILETS <br /> D TATTOOMODII PHERCING ❑ POOLISPA 4 LAND USE APPLICATION SITES <br /> 13 MEDICAL WAST$FACILI Y 0 OTHER(PLEASE OPECIFYi <br /> 1. List up to ten addresses in the apace above. Select the types)of filen from the list above by checking <br /> the Oppropdafe box(es). At least one file type MUST be selected. Fax to(209)464.0138 or ria)_l to the <br /> 2. EAD will notify#w applWant if any EHD files exist An appointment for review will be confirmed <br /> approximately five business days but no later than ton(10)days after receipt of application. Tice fifes <br /> will be held for a maximum of fhre busineare days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHO staff may net 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 RHO 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. 'TENTA appoh*nent dates must be confirmed with END staff, <br /> 6. Applications received after 3:00 pm will be proceaared the next business day, <br /> CONFIPJMD APPOINTMENT DATE <br /> CIATE COMRMED Pee+iLit°Fax Note 7671 640--311-5704=0- 1 <br /> REVIEWED YES NO TO Ou Nt�C C& � QtrG hod <br /> ann �`Kletinte. rter °o <br /> ra6s Phone a rram <br /> 09/13/2004 VON 11:18 [73/RX NO 72731 Q001 <br />