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TDA T c RECEIVED <br /> �. <br /> I- SAN JOAQUIN COUNTY VIS iVU(vl <br /> Ir� (J � �' ��'I[�� 'l�',"IRONIVIk.N' �.>`I��.CAS. HEALTH.DEPARTMENT <br /> 304 E Weber Ave 3''d Floor Stockton, CA 95205 <br /> NOV 1 4 2003 (209) 468-3420 Fax: (209) 464-0138 Web; www,c0,San-j0aquin.ca.u�the <br /> ENviRUNMENT HEALTH PUBLIC RECORDS It1u.L1EASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY:` - <br /> ADDRESS: OYUd <br /> PHONE: <br /> FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: <br /> Time* <br /> Py(Pleayaa allow 10 buslnuss pays from date of dpplicatlon subrni I <br /> rj CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUES PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE _&4u- <br /> FILE ADDRESS <br /> .. Department use only <br /> 5veel UNIT <br /> '� liUutl .y <br /> -3. Slreel t. Ci Unit <br /> city f �) <br /> 4. Sheet `I Unit <br /> GI <br /> 5. Slrcel a � <br /> e• Svout Cu ( `�\� <br /> ul Unit 3 <br /> 7. 31rew � � � , <br /> cn <br /> 8. suool ?r 1,A,I)L, Unit 4 <br /> 1�77 <br /> strecl � <br /> CII , <br /> sheet I _� _ Unit 5 <br /> a <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES B/�'� <br /> i� DERGROUND TANK(UST)CLEANUP SITE(LOP) k HOUSING ABATEMENT �J ,7` —` <br /> � r&ITMER CLEANUP SITE(NON-LOP) WFOOD FACILITY O SOLID WASTE FACILITY � <br /> 7F ERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ SOLID WASTE VEHICLE Jti <br /> AZARDOUS wAs-rr-GENERATOR ❑ CHICKEN RANCH O DAIRY <br /> TIERED PERMITTED FACILITY rj ❑ PK TREATMENT PLANT <br /> ❑ TATTOO/BODY PIERCING MO POOLISPA EL ❑ MPER TRUCK/YARD/CHEM TOILE'T'S <br /> ❑ MEDICAL WASTE FACILITY 13 OTHER(P Or LAND USE APPLICATION SITES <br /> ❑ OTHER(PLEASE SPECIFY) <br /> • List up to ten addresses in the space above, Select the t <br /> thea ype(s) of files from the list above by checking <br /> ppropriate box(es). At least one filo type MUST be selected. Fax to(209)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant it 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, <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> END 48.92406 <br /> WW2003 <br />