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03/18/2005 11:59 FAX 209 9480, Q1002 <br /> TE� REGEIVEL? cnV"•• "V•.,••",J SAN SOA QUIN COUNTY <br /> n ENvjpoNNLEN cA`L HEALTa DEae�TNMNT <br /> WE SYE 304 E Webevkve 3"1 Floor Stockton, CA 95205 <br /> VAR I(� %%9-3420 Fax- (209) 464-0138 Web: www.co.m joaqu4Lca&ehd <br /> tI,VtRoy ,ENT tEAUPUBLYC RECORDS RELEASE A13PLIC.ATION <br /> APPLICANT_,L4W t b5� BusINESSiAGEHCY: <br /> PHONE_ FACSIMLE: <br /> TENTATIVE'APPO1lTlV2NT DATE' nme• <br /> (Please allow 10 businrss dayx from data of application suhmi[f2ll <br /> E) CHECK BOX TO EXPEDITE REQUEST-153-00 FEE-REQUEST PROCESSED IN 3 allSINF-SS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> ' Department Lfsa Qn1Y <br /> UHrr <br /> LJE ADDRESS <br /> sem+ r G J ❑ Unit 1 <br /> 2 d+l�5 G ll,U <br /> a. s� rut 2 <br /> Unit <br /> p r` <br /> 6, 54+Ce� <br /> , nit 4 <br /> T. s� <br /> cry <br /> `- ❑ Unit 5 <br /> s. str� <br /> ENVIRONMENTAL V- EA1.TH DEPARTMENT FILE5 L <br /> UtmERGROUND TANK(UST)CLEANUP SITE(Lop) 1:3HOUSING ABATEMENT Nt,SOLID WASTE FACILITY <br /> ❑ FOOD FACILITY ❑ SOLID WASTE YEFi1GL.E <br /> OTHER ct.5-muP SrrE(NON�OPy o o4G KENNEL 19'DAIRY <br /> C. <br /> a UNOERGROUND TANK(MoNrTORIHMEMOVAL) ❑ CHICKI N RANCH �-PKG TFlEA.TMEHT PLANT <br /> l>a. KAZARnaUS WASTE GENERATOR 13 M4TELlHO AN A PUMPER-rRUCKr'rARD1CHEM TOILETS <br /> ❑ TIERED PERMITTEn FACILM ❑ POOELIHOLISPA LAND US>=AppLICATION nab <br /> ❑ MEMCALWASTATTOOIBODY PIERCING 0 OTHER(PLEASE SPECIFY) <br /> [] 1ulEflICALwASTI=FACILITY <br /> 1. List up to ten addresses in the space above. Select the type(s) of Files fram the list aboye by checkinc <br /> the appropriate boxes), At least one file type MUST be selected. Fax to 209 464-0138 or mail to the <br /> address.indicated above_ <br /> Z. EHO will notify the applicant if any EHO files exist- An appaintmer�t far review will Ehconfirmed The fids <br /> approximately five business days but nO later than ten (10) days after receipt of application. <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 EMD staff may not be immediately available For review- A no <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[~HD staff at the expert` <br /> of the applicank_ Future file reviews by the same applicant may require A $93.00 deposit prior to revi4 <br /> 5. OTENTATNI= appointment dates must be confirmed with EH❑ staff. <br /> g, Applications received after 3.00 pm will be processed the next business day. <br /> :aC FIRM �- .PPOINTMENT�A7E` ::r ..k111.. <br /> •',r;; PHOME 'FAX <br /> REVIEWED YES NO REVIEYV DATE" <br />