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TERRACON - RENO Fax:775-351-2423 Nov. 4 2003 13:47 P.01 <br /> t SAN COUNTY <br /> Q' I \� C�t /1 EHD LOG NUMBER <br /> L' I—' <br /> NOV 0 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> 1=NVIRONMEI`d 1999 -3420 Fax: (209)464-0138 Web: www.co.san joaquin.ca.us/chd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C) MS E, BUSINESS/AGENCY:___•TL—Z•kAC'0 <br /> ADDRESS:.._L 3 8O 6fz E6 c7 # 233 S p4k" Ivw 4 Ltd _ <br /> PHO5'I "2-t{OO FACSIMILE: RIZ 3S Z��3 <br /> �TJEWXATIU� TMENT DATE: Jr9t&,, M QV Jj Time: ��Lp±a' <br /> (Please allow 10 business days from date of application submittal) <br /> "I ,x <br /> CHE BOX TO�QUEST-$83.00 FEE—REQUEST�PROCESSED 1N 3 USINESS DAYS <br /> SIGNATURE OF APPLICANT L4)rrry <br /> DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> +. sit-, 5, S 'T. c. LO� ASO <br /> street IQ v.1 C,'" DT p El Unit 1ty <br /> ? <br /> a. atm SY city +. <br /> .. s a N -S s 5 <br /> Unit 2 <br /> c. t <br /> V st o 2 W AL#T(' S7. c; 1 t <br /> 6. I t <br /> T stroct .1y <br /> 109 a2 ti�k e. b`T S O 5"f Unit 4 �?\ <br /> 8. sw F fttNtf"Y' el, I+ <br /> +o. strret 01 C'CNTTI ht P(- t c. 4monr7manTnit 5 v <br /> ^rr� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Q "DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0110, 11)WASTE FACIRL <br /> r O , <br /> � HER CLEANUP SITE(NON•LOP) 4 FOOD FACILITY ❑ SOLID WASTE VEHIsJMDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL Q DAIRY � <br /> Sl ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY M MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PIERCING d POOUSPA <br /> E3 MEDICAL LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY} <br /> 1. List up to ten addresses In the Space above. Select the types)of files from the list above by checking <br /> the appropriate box(ea). At least one file type MUST be selected. Fax to(209)464.013$or mail to�t <br /> Icat t) ve. ® <br /> 2. EHD will notify the applicant If any EHD 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 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 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 expense <br /> Of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3.00 pm will be processed the next business day. p� <br /> CONFIRMED APPOINTMENTDATE jI-I TIME `f <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 00-y7-0G6 <br /> orenooa 11 y iJ>,. /JJ <br /> Ur i,oS jS7GC[,J7. �f <br />