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DATE RECEIVED LHU LUU NUl+ioLn <br /> - SAN JOAQUIN COUNTY <br /> ENI. _-. _ONMENTAL HEALTH DEPARTi . _ '.NT <br /> Pi 5' I , • ; ;{ I, ,tN I F i , rl 'tAl- 1IB04 E Weber Ave 3`d Floor Stockton, CA 95205 IL4 � � <br /> �' . . I+(3'( 9'S `46 1(3420 Fax: (209) 464-0138 Web : www . co .san-joaquin.ca. <br /> AUG 13 AM IbALIC RECORDS RELEASEAPPLICATION <br /> APPLICANT: Z41V b c_ t BUSINESS/AGENCY: �- <br /> ADDRESS : �3C7- `G'�F �/ G� 6c-rcl �l�c � .CT <br /> fZrc: ;'` C_ ✓ � /` <br /> PHONE : �✓ /7 - Y��/ FAC/SIIMILE : <br /> TENTATIVE* APPOINTMENT DATE : F�U ';)-6os Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST $93.00 FEE - RE LEST PR CESSEEDD IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT f �O � voiGC L_ DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1 . so-eet % c 3 --� 6 7`f cit - <br /> ❑ Unit 1 <br /> 2. Street Lii� d e< -x"D _7 E7 01 0 e <br /> D3l7 ct a. street 5 <br /> E] Unit <br /> 4. Street 3C11V cit <br /> Street <br /> City <br /> Unit 35. <br /> t— <br /> 6. Street <br /> Di " <br /> 7. Street e/ 50 ��x_Gtif -! •i n . Cit Unit 4 <br /> 8. Street Cil <br /> 9. street Citynit 5 <br /> 10. street Qt <br /> / <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES l '�I J <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY �- <br /> ❑ OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 'RI UNDERGROUND TANK (MONITORING/REMOVAL) 13DOG KENNEL ❑ _ DAIRY <br /> p HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ ' PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY Cl MOTEUHOTEL ❑ PUMPER TRUCKlYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <br /> ll <br /> 1 . List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> it the appropriate box(es) . At least one file type MUST be selected . Fax to (209) 464-0138 or mail to the <br /> j address indicated above. <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 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 /> EHD 48.824)06 <br /> 8/8/2003 <br />