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STOCKTON <br />209 983 6960 <br />11/25/2E303 12: 13 <br />46A01 <br />: ENVIRONMENTAL WeHCr PAGE BI <br />5 <br />. SAN JOAQUIN COUM-Y <br />NOV 2 5 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br />304 E W ober Ave 3`l Floor Stockton, CA 45205 <br />468-3120 Fax: (209) 464-013$ Web: wwtiv.co.sa-joacluin.ca.us/ehd <br />PUBLIC RECORDS RELEASE APPLMATTON <br />CADPDRESS: <br />�1UILICANT: Y r ` r BUSIIN�ES""SIAGENCY, NES,OC-70 <br />�-c..�kUIN PVUJ � �4 , Ti r.k1_7081 <br />ONE:O-[ t,. �C C/l DFAG$tMILE: O �� <br />�[J <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 buslness days from date of application 9Ubrnittal) <br />CHECK SOX TO EXPEDITE REQUEST - $93.00 FEE - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />_*SIGNATURE OF APPLICANT <br />DATE <br />ENVIRONMENTAL WEALTH DEPARTMENT FILES <br />Department Use Only <br />FILE ADDRESS <br />1. <br />��++'-}� <br />Siren, V <br />�/ ) <br />gemy' L w <br />Gry <br />Z <br />Std, j f <br />2 <br />10j Unit 2 <br />-yG <br />S. <br />3Ve <br />lty— <br />CI <br />6. <br />91(8 <br />G <br />s. <br />s <br />Ci <br />6, <br />Street <br />G <br />7. <br />Street <br />8. <br />stmt <br />- <br />�{ <br />9. <br />Strtel <br />C <br />19. <br />&reel <br />G <br />ENVIRONMENTAL WEALTH DEPARTMENT FILES <br />4 <br />_j;UN[IERGROUND TANK (UST) CLEANUP SITE (LOP) C1HOUSING ABATEMENT 0 SOLID WASTEFACILITY <br />0___0THER CLEANUP SITE (HON -LOP) C1 FOOD FACILITY 0 SOLID WASTI;'vEtllcl rw <br />i+Q UNDERGROUND TANK (MON ITORIN GIREM OVAL) 0 DOG KENNEL J'> DAIRY <br />Cl <br />0 HAZARDOUS WASTE GENERATOR CI CHICKEN RANCH PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY 0 MOTELIHOTEL y� ❑ PUMPER TRUCK/YARDICMVM TOILE <br />TATTOOlBODY PIERCING 0 PCj 011SPA t�0 D USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY IL"TRER (PLEASE SPECIFY) <br />sfc <br />1.'. List up to ten addresses in the space above. Select the type(s) of files from the list above try 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,' EHD will notify the applicant If any EHD fifes 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 ne <br />application may be submitted When the file Is available. <br />4: Any file not returned in the same Condition as released will he reorganized t =Strad" e <br />of the a licant. Future file reviews by the same applicant may require a $ _ <br />PP <br />5: *TENTATIVENT*TENTATIVEappointment dates must be confirmed with EWD staff. <br />g; Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APP(jINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />kEVIEWED YES NO. REVIEW DATE <br />EnD 48-42.096 <br />erer2aos <br />Department Use Only <br />UNIT <br />7 <br />❑ Unit 9,`�� <br />10j Unit 2 <br />Uni <br />4 <br />_j;UN[IERGROUND TANK (UST) CLEANUP SITE (LOP) C1HOUSING ABATEMENT 0 SOLID WASTEFACILITY <br />0___0THER CLEANUP SITE (HON -LOP) C1 FOOD FACILITY 0 SOLID WASTI;'vEtllcl rw <br />i+Q UNDERGROUND TANK (MON ITORIN GIREM OVAL) 0 DOG KENNEL J'> DAIRY <br />Cl <br />0 HAZARDOUS WASTE GENERATOR CI CHICKEN RANCH PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY 0 MOTELIHOTEL y� ❑ PUMPER TRUCK/YARDICMVM TOILE <br />TATTOOlBODY PIERCING 0 PCj 011SPA t�0 D USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY IL"TRER (PLEASE SPECIFY) <br />sfc <br />1.'. List up to ten addresses in the space above. Select the type(s) of files from the list above try 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,' EHD will notify the applicant If any EHD fifes 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 ne <br />application may be submitted When the file Is available. <br />4: Any file not returned in the same Condition as released will he reorganized t =Strad" e <br />of the a licant. Future file reviews by the same applicant may require a $ _ <br />PP <br />5: *TENTATIVENT*TENTATIVEappointment dates must be confirmed with EWD staff. <br />g; Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APP(jINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />kEVIEWED YES NO. REVIEW DATE <br />EnD 48-42.096 <br />erer2aos <br />