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Seo . 4 . 2003 12 :43PM CONO ERPTH TECHNOLOGIES � No .4al9 P . 1/1 � <br /> '. <br /> LAI=ny�crvcu SAN JOAQUIN COUNTY cnu LuG NUN <br /> Lii,/, r r ENVIRONMENTAL HEALTH DEPARTMENT <br /> L t,nl_ail \� I 1� <br /> 304 E Weber Ave 3N Floor Stockton, CA 95205 <br /> Joaquin <br /> I �� <br /> SEP` 0 4 2aaV9)468.3420 Fax. (209)4640138 Web: www.cO.Saa joaquiv.mus/ehd <br /> Nvir;UNMENT HEALTH PUBLIC RECORDS RELEASE/APPLICATION <br /> APPLICANT' �T�S _�{ bL�J:'�`I�1 ' BUSINESSIAGENN"C'Y: �CJ__O �fl H' <br /> ADDRESS. d 6 GCF Jr �5 oc FOTO <br /> �4r 053 <br /> PHONE�� l1 _ u Or7 I iC FACSIMILE: p <br /> TENTATNE`APPOINTMENT DATE: I S ����•��Time: D %� A phi . <br /> (Please allow to business days from date of application submittal - <br /> CHECK BOX TO EXPEDITE RE4UES ?.00 FEE•- QUEST ROCESSED INa DAYS •03 <br /> `jJ_ _T__T_ DATE t <br /> SIGNATURE OF APPLICANT Department Uee Only <br /> UNIT <br /> FILE ADDRESS <br /> �. strew O w• J�C� G c�'E0/1 ❑ Unit 1 <br /> a <br /> 2 svan <br /> } Btreet -I <br /> .'_. ..�' .� r,34n/S•Lim t710.5tatz <br /> tnit <br /> ILS 51 <br /> c <br /> s" 'kN { . 55 <br /> 7. o Ll in y G <br /> { 1-11 <br /> 9. Strwt <br /> o✓tV7 fi, G <br /> G <br /> 10. 6 <br /> ENVIR NMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT Ilk SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY 00 SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 12DOG KENNEL ❑ DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) C3 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RAN 0 PUMPERTRLICK[yARD1CHEM TOILETS <br /> iI TIERED PERMITTED FACILATY ❑ MoTELIPOOMPA (Sf LAND USE APPLICATION SITES <br /> ❑ 7ATT00/BODY PIERCING ❑ OTHER(PLEASE.`RPEr-'� --`— <br /> MEDICAL WASTE FACILITY , I (', checkln! <br /> f 'Jl sta3$. o¢Y <br /> 1. List up to ten addresses in the spa I ( O I -0198 0_ _ r mai_ 1 to the <br /> the appropriate boX(es). At least o / <br /> address indi arc ted.above_ be confirmed <br /> 2_ EHD will notify the applicant If any Iplicatlon. The flies <br /> approximately five business days t t be scheduled <br /> will be held for a maximum Of five t <br /> accordingly. >y Ile for review. A ne' <br /> 3. A file that is actively being worked t <br /> application may be submitted when staff at the expens <br /> 4 Any file not returned in the same Co posit prior to revie+ <br /> of the applica Future <br /> eit <br /> 5. 'TEN7A7Vappointment daes mu: <br /> 6. Applications received after 3:00 pm <br /> CONFIRMED APPOINTMENT DATE. <br /> DATE CONFIRMED <br /> REVIEW DATE' <br /> REVIEWED <br /> YES NO <br /> �ae.a:mc <br />