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—~ ' Nov 12 03 03: 58p <br /> 11/12/2bM3 11:24 4646136 EM11R01ihENTAL HEALTH PAGE Bl <br /> GATE RECEIVED EHO LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3 Floor Stockton,CA 95205 <br /> N 0 V I A2 8-3424 Fax:(209)464-0136 Web: www.c0.5an-jviLquin.ca.us/ehd <br /> ENVIRONMENT f- PUBLIC RECORDS RELEASE APPLICAMN <br /> SE <br /> RA E,, rr <br /> APPLICANT L BuSINp5wAO IENCY:� <br /> �. anDREss: — <br /> T H. �J T S 5I <br /> HONE; — 33 9Z FACSIMILE; �NO ^ <br /> TENTATIVE"APPOINTMENT DATE: � E f S r 0✓_ -—nme: A <br /> LIS <br /> (Please allow 10 business days from dale of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93-00 F E- EQUEST PROCESSED IN 3 DUSINESS DAYS <br /> (SIGNATURE OF APPLICANT 10 DATE <br /> F6 TG --DAV I D SMLU L-7-40►1 D"adment Use Only <br /> FILE ADDRESS UNIT / <br /> E 0 'Z-rr Unit I / <br /> a. 9aeel ❑ Unit 2 "A �7) <br /> 5, sura G Unit 3 \f <br /> r. S1 Unit 4 <br /> e. sacci <br /> s <br /> strest 0tv Unit 5 <br /> 10 MrLal <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ 30LID WASTE FACILITY <br /> * OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY CI SOLID WASTV VEHICLE <br /> * UNDERGROUND TANK(MONITORINGIRGMOVAL) 13 DOG KENNEL ❑ DAIRY <br /> JQ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY O MOTELIHOTEL ❑ PUMPER TRUCKlYARDICHEM TOILE <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA O LAND USE APPLICATION SITES <br /> 3 <br /> 0 MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPEGIi"Y) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the;llst above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2051464-4138 or�lail ta_tjjo <br /> address indicated above. <br /> 2. EHD will notify the applicant it any EH13 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 tiles <br /> will be held for a maximum or five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A File that Is actively being worked on by EHO staff may not be immediately available for review. Anew <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will b reorganized by EHO staff at the expense <br /> of the applicant. Future file reviews by the same applicant m y require a$93.06 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be confirmed with EH10 staff. <br /> g, Applications received after 3;00 pin will be processed the no)t business day. .3 <br /> ii <br /> CONFIRMED APPOINTMENT TATE TIA E <br /> DATE CONFIRMED PHONE'. Fj X INITIALS <br /> REVIEWED YES NO REVIEW I ATE <br /> NIU 4642400 . <br /> HY204! <br />