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:46PM " Nei I' 0. Anderson & ASSOC. No4226 IrlP. 2'NU�;:,� <br /> SAN JOAQWiN COUNTY-., . <br /> FEB 1 7 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> ENVIRONMENT AM}A68-3420 Fax: (209)464-0138 Web: www.co.san_joaquin.ca.us/ebd <br /> . PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: (2&CC-io __ - BUSINESSIAGENCY: <br /> q IV�t O ' t�v�dQi+r S.dam <br /> ADDRESS: ! D Z , 115 �( Y"�M tAA -1 <br /> PHONE: 519-4 FACSIMILE:—3(o' <br /> (o'9 Lf 8 <br /> TENTATIVE-APPOINTMENT DATE:^ '31-.,-10`'f Time: a <br /> (Please allow 10 business days from date of application,submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST- 93.00 FE -REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> Street 3311 W y-,^.e- S}' city �` ` 7n ❑ Unit 1 <br /> 2. Street 2-60 6� rn <br /> 3. Street 223 lN• V�c�S x•11 , L, city �•� 3 ❑ Unit 2 / //j�,,.� \ <br /> ,. Street ?-%5 W- k..^ Orr <br /> s. street q3 •}� Unit 3 <br /> 6. Street 1 O ~d C t g� <br /> 7. Street ] C�• .�y„�`1 d C' t Unit 4 <br /> 8. 7 J V' 14 �` Cit m <br /> L]]L <br /> t 5- <br /> 3 1 - S' t 6Y� nl0. 304 caua � iz'eon <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 14 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> QJ OTHER CLEANUP SITE(NON-LOP) <br /> ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> p DOG KENNEL ❑ DAIRY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> it HAZARDOUS WASTE GENERATOR 11 MOTELMOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILET: <br /> ❑ TIERED PERMITTED FACILITY ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICALTATTOO[ WASODY PIERCING ❑ OTHER(PLEASE SPECIFY) - <br /> ❑ MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checkit <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to tht <br /> 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 file <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 r <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 expel <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to rev <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 /> E},D 48-02-006 _ <br /> M003 <br />