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04/06/2005 09:56 FA 2209 9480 U002/002 <br /> DATE RECEIVED <br /> SAN JOAQULN COUNTY <br /> ENvzRONitiIENTAL H>;Az,Tx DEPA1tTiYiENT <br /> 304 E Weber Ave 3b Floor Stockton, CA 95205 / _ ` 7 <br /> 6 200 09) 468-3420 Fax: (209) 464-0138 Web: www.co.sanjoaquin.ca,us/ebd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICA110N <br /> ,��,TICC )�irGc <br /> APPLICANT: 7��ny'_J415 eUSINESSIAGENCY: /.Elft Ida <br /> ADDRESS: a aZS- j / �'� wry i- <br /> PHONE: kgE) ITeIs FACSIMILE: (oTC1Z� 948-c>�au <br /> TENTATIVE'APPOINTMENT DATE:, Time: LRQ <br /> (Please allow 10 business days from dale of appUw6on submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT yll) DATEY/66,62�_, <br /> DCparunent Use Only <br /> FILE ADDRESS UNIT <br /> I. s. W i a ❑ . Unit 1 <br /> 2 amt '40 aty N <br /> 3. so- t a o N Unit 2 _IJIjj L4_0 5 <br /> rN s,..,I IgA o <br /> sr� a /4 # v <br /> +. Unit <br /> 3 <br /> t, sa�el -O C w " 4 <br /> e, so-ee oo Ar, Avt " <br /> s. s� 'Vk'�C;Ke, GZ e3 c " L ❑ Units <br /> n <br /> ta, Seca .r't aat� CRY <br /> X 71f <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(u5T)CLEANUP SITE(Lop) ❑ HOUSING ABATEMENT M.SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NOWLOF) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> iii� UNDERGROUND TANK(MONITORINCRtEMOVAL) ❑ DOG KENNEL M DAIRY <br /> Z HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH 19L PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY O MOTELIHOTEL ❑ PUMPERTRUCKNARDICHEMTOILPTS <br /> O TAYTOOIBOOY PIERCING ❑ POOLISPA Ito. LAND USE APPLICATION SITES <br /> Q 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)464-0136 or mail to the <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 rive 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 ne' <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 experts <br /> of the applicant. Future rile reviews by the same applicant may require a $93.00 deposit prior to revie <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the nextbusiness day, <br /> ZZ <br /> N APPOINTMENT'.IjATE' <br /> O FIRM D. IM <br /> DATE CONFIRMED "PHONE . FAX '•%)NITIALS <br /> REVIEVVED YES NO REVIEW DATE <br />