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11/07/2003 16:12 9168610430 SECOR PAGE 01/0 <br /> DATE RECEIVED EHU LU(;NUMW-_r <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ( 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> 209)'4�i8T .4Z0 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca us/ehd <br /> NOV 0 7 2003 PUBLIC RECORDS RELEASE ,APPLICA.'I'ION <br /> i NVIRUN t T L� <br /> APPLICApBUSINESs/AGENCY: S�CLoCL t rf�r{-EL�tirlctL t�[Gc r it7 7a <br /> v <br /> ADDRESS: o i--f x1VyaVti r-Arg,kc, c ;t n 4- ,CA QS 7r2 <br /> PHONE: %t 8'1 7-S FACSIMILE:�� �r 1 5stcl�ay3o <br /> TENTATIVE"APPOINTMENT DATE: if J/8_ Time: Jo:m.A&' <br /> (Please allow 10 business days from date of application submittal) - <br /> Q CHECK BOX TO EXPEDITE REQUEST-$93.00 FE —REQ ST PROCESSED IN 3 BUSINESS DAYS r - J/ <br /> SIGNATURE OF APPLICANT DATE 8(7/0 <br /> Department Use Only 0. <br /> FILE ADDRESS UNIT <br /> ,. suet > V ra ❑ Unit 1 <br /> cit <br /> 3. Street V V V v oty 292SLPIl <br /> 4. Street a V C41Y 5 7Z?9 <br /> S. Street 1/HOTE V Dt K'7b !Unit <br /> 5. street �t pdc,C 64 gw cue � Glry srL�k7�aG ✓✓ <br /> 7 Street l`IZ� E �l G a. strcn pct <br /> 10, street CI h V%Unit <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES V% <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> 131 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MON ITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY qw*v <br /> G7 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ PUMPER TRUCKIYARDlCHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING 0 POOUSPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by 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. END 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 nev <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 expens( <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to reviev <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. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS , . <br /> REVIEWED YES NO REVIEW DATE <br /> EN 48.02.000 <br /> t3r8J2oaa . <br />