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11/07/2003 16:12 168610430 SECOR <br /> PAGE 01/0 <br /> DATE RECEIVED EHD LUT;NUMbtK <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton CA 95205 <br /> �20y 4 8- �0 Fax: (209) 464-0138 Web: www.co.san-joaquin.caus/ehd <br /> NOV 0 7 2003 USLIC RECORDS RELEASE APPLICA,'T'ION <br /> 1 IV`/I(iUNt <br /> APPLICA�J� 7 BUSINESS/AGENCY: (Z 1 A'nW n4 fgr#J PIET�7) <br /> f ' xLo <br /> tf/OtAIVIUES <br /> ADDRESS: --r E rb <br /> PHONE: yl(v $Rol Z. 3 FACSIMILE: �4 SCO/"arJ-19 <br /> TENTATIVE APPOINTMENT DATE: 1118 -710 43Time, Jo:02 A <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE EQUEST-$93.00 FE -REq ST PROCESSED IN 3 BUSINESS DAYS ( - J <br /> SIGNATURE OF APPLICAN DATE a f7/a3 <br /> Deoartment Use Only 0 <br /> FILE ADDRESS UNIT <br /> '- sv�nt a ❑ Unit 1 <br /> 2. strew rS UA \` \�' \. CI t ({ 77 <br /> 3. Street V \�. v v G -phL <br /> El <br /> 4. stre•_t F' .{ v V aly s a/1C <br /> G, l <br /> 5. street °I HO 7� v V t'7b <br /> Unit <br /> G, street iVw LIrAa/N A [Dt an 57Mk7D9 <br /> 7. Street e` 2-(o E G Unit4 <br /> H. 8trerl `L C e LiG e <br /> S. StrcN c+ U ❑ Unit 5 <br /> 10, Streetr- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST) EANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> IRI OTHER CLEANUP SITE(NON-L P) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONIT RINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Rr HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING O POOLISPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten add sses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate bo (es). At least one file type MUST be selected. Fax to(209) 464-0138 or mail to the <br /> address indicated bove. <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 aximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is active y being worked on by EHD staff may not be immediately available for review. •A nev <br /> application may b submitted when the file is available. <br /> 4. Any file not return d in the same condition as released will be reorganized by EHD staff at the expens( <br /> of the applicant. F ture file reviews by the same applicant may require a$93.00 deposit prior to reviev <br /> 5. *TENTATIVE appoi tment dates must be confirmed with EHD staff. <br /> 6. Applications recei ed after 3:00 prn will be processed the next business day. <br /> CONFIRMED APPOINTME T DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EMb 49-02406 , <br /> e/=002 <br /> IG.. .► t<<M CAnpatl I <br />