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i <br /> DATE R GFNED EHD LOG NUMSER <br /> SAN JOAQUIN COUNTY <br /> EN'V'XRONMENTAL HEALTH DEPARTMENT <br /> LT 2 7 20 <br /> 4 <br /> 304 E Weber Ave 3rd Floor Stockton CA 95245 <br /> 93 <br /> 209 468-3420 Pau: 209 464-0138 Web:www.co.san-joaqtun.ca.us/chd Z0 <br /> L T. r tj I. <br /> JL, PUBLIC RECORDS RELEASE APPLICAZTON <br /> APPLICANT. 6,0 Int? SUSINESSIAGENGY: C^vc v ' 4Z't ,.,OJ `5 +�C• <br /> 'ADORES$: C4 �si-ned- Ga,lcar.� - d <br /> PHONE: 35 5--1 11�� FACSIMILE: $ ECOPY <br /> TENTATIVE"APPOINTMENT DATE: tt I�d V—1 Time: V.00 04—, <br /> (Please allow 10 Dushvms days from date of application suhrnittai) <br /> ' CHECK BOX TO EXPEDITE REQUEST,"3.00 FF •-REQUEST PROCESSEp IN 3 OWNES3 DAYS <br /> ' 310HATURE OF APPLICANT v DATE <br /> lDeimmom Liza Ov* <br /> ---FILE ADDRESS UNIT <br /> t. Street <br /> SA���S same p ❑ Unit ! <br /> # <br /> a e Unit: A <br /> � sooet � �O <br /> x Unit 3 kN <br /> & stv.tCft <br /> z. spa I-O/UnK4 <br /> 0, CRO <br /> ❑ Unit 6 <br /> 10, santCkvLX <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> AUNDERGROUND TANK(UST)CLEANUP SITE(LOP) C7 HOUSING ASATEtAENT ACsOL ID WASTE FACILITY <br /> ,[ OTHER CLEMUP SITE(NON-.OP) D POOR FACII FTY 0 SOLID WASTE VEHICLE <br /> !�UNDERGROUND TANK(MONITMNGIREMOVAL) O DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR :3 CHICKEN RAINICH J0 PKG TRF-ATIMENT PLANT <br /> TIRM Pr:rfWTTED FACILITY Q MOTEL(HOTEL 0 PUMPER TRUCWYARDICHEIM <br /> 0 TATTOOMODY PIERCING 0 POOLIBPA LAND 9E APPLICATION SrTEB j� I(� <br /> G MMCAL WAS'T'E FACILITY Or OTHER(PLEASE$PEGIFY) L J�'tla�'Z.. - _T <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by lcheclting <br /> the appropriate box(es). At least one file:type MUST be sehwted. Fax to(209)464.013$orhail to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be Confirmed <br /> approxirnstely five business days but no later than ten(IQ)days after receipt of appiloation. The files <br /> Will be hold 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 expen$e <br /> of the applicard. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> S. *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 /> CQNFIRNlED APPOINTMENT DATE TIME <br /> DATE CONFIRMED --- PHONE FAX INITIALS <br /> REVIEMD YES NO REVIEW DATE <br /> END 4&W-M ,°•••. _ <br /> 818u14D3 <br /> Td Wd5Z:TO V00Z zZ '}D0 €686 828 60Z : 'ON ONOHd stsFilPuu oaaZ punoa0 WOiw <br />