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11 / 20 / 2003 09 : 59 FAX 4155 ' 041 'fRGADR'ULI. & ROLLO A001 <br /> 11 / 19/ 2003 14 : 49 464 .: 6 ENVIRONMENTAL rIEALTH PAGE 02 <br /> DATE RECEIVED 4640138 <br /> � [ -' fr? k JOAQUIN COUNTY EHD LOG NutiluLr <br /> —� <br /> it I ` ' tl III ) EN • -IRONMENTAL HEALTH DEPARTMENT <br /> N 0 V 2 0 2003 304 E Wcbcr Avc 3id Floor Stockton, CA 95205 <br /> (209) 463-3420 Fax : (209) 464-0138 Web : wvrw.co .sanjoaqtiin.ca.us/clid I <br /> ENVIRGNMEN 1 i ii: Al- i f , <br /> PERMIT/SERVICES ( PUBLIC RECORDS RELEASE/APPLICATOyION <br /> APPLICANT: ��^'� I �"'( :/ t'Fth1 BUSINE`SSIAGENCY: • I VgadW 4 4 0 <br /> ADDRESS: . SS 5 /✓IDN• { GiV e1 ry� i S --) • d � � � y(] L G u <br /> PHONE: 1115 qoL( y I FACSIMILE: <br /> TENTATIVE' APPOINTMENT DATE: II�Z 01 /D3 Time: " !!;• !- <br /> (� <br /> (Please allow 14 business days' rrom date of application submfital) <br /> C9 CHECK BOX TO EXPEDITE REQUEST - 5/9y Oe E - •QU T PROCESSED IN,3 BUSINESS DAYS <br /> SIGNATURE OF .APPLIOANT (rte DATE , U <br /> / Deparlment Use Only <br /> 7 .FILE A60905 <br /> L $ <br /> 1. strerl r c9 <br /> 2. Street CII- { - . ❑ . Unit 1 <br /> 9. street City Uv1 ❑ Unit 2 <br /> • . 911ee1 <br /> air, <br /> S, sates coy 1 <br /> S. slfeet - ell <br /> r. sirett GaypUnft <br /> e, sheat CII9. street ea <br /> 10. seed city t <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES t <br /> UNDERGROUND TANK (UST) CLEANUP SITF (LOP) ❑ HOusiNG ABATEMENT ci SOLID WASTE FACO <br /> OTHER CLEANUP SITE (HON•LOP) - 0 FOOD FACILITY - ^ ❑ 'SOLID WASTE VEHICLE <br /> Jp( UNDERGROUND TANK (MONITORINGIREM OVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL O PUMPER TRUCIWARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POO ISPA ❑ 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. EHD will notify the applicant if any EHD flies 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 daysJor 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 he reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 o t p 'or re e <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 days <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> I <br /> REVIEWED YES NO REVIEW DATE <br /> EHD +e•oz.auc <br /> eiu2oos — <br />