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06/22/2004 11:59 303767 z9 TECHLAW INC PAGE 03/0 <br /> EHD LOG NUMBER <br /> QATE_REcz1VSD--, ,, SAN JOAQUIN COUNTY <br /> P t�D ENVMoNMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'd Floor Stockton,CA5 0n.ca.uslehd <br /> 25 <br /> JUN 2 2 2Q989)469-3420 Fax: (209)464.0139 Web: www• Jo Gu <br /> ENViRUN,'EN T HEALTH PUBLIC RECONS RELEASE APPI KATION <br /> BUSINESSIAGENCY: � <br /> APPLICANT. <br /> pOORESS: <br /> MILE 11 .7/ O" "7— <br /> U3 <br /> PHONE: _ FACSI <br /> Time: <br /> TENTATIVE'APPOINTMENT DATE: <br /> (Please allow 10 businaso days trom date of appllcaUon submNlal) <br /> El CHECK BOX TO EXPEDITE REQUEST•$93.00 FEE—REQUEST PROCESSED IN a BUSINESS DAYS -E <br /> SIGNATURE OF APPLICANT Deoartmem Use C tv <br /> UNIT <br /> FILE ADDRESS R <br /> p Unit 1 <br /> 6;nht 2 <br /> s. so-nec a <br /> sima nit 4 <br /> swan <br /> LO a 7 RUF 0 Unit5 <br /> 5 9ww <br /> 1� G <br /> �o sam <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> D HOUSING ABATEMENT t+ SOLID WASTE FACILITY <br /> UHOERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> ¢Zt OTHER CLEANUP SITE(NON-LOP) 0 ppb•KENNEL E3 DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH P pKG TREATMENT PLANT <br /> yx HAZARDOUS WASTE GENERATOR O MOTEUHOTEL ❑ PUMPER TRUCKMARDICHEM TOILETS <br /> C] TIERED PERMITTE0 FACILITY ❑ POOLISPA O LAND USE APPLICATION SITES <br /> ❑ TATTOOMODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> El MEDICAL WASTE FACILITY checking <br /> 1- List up to ten addresses in the space above. Select the types)of files from the list above m 9 <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-013$or mall to the <br /> address indi fyted above. appointment for review will be confirmed <br /> 2. EHD will notify theapplicant if any EHD files exist. An appo s after receipt of application. The files <br /> approAMatety five business days but no later than ten (10)day <br /> will be held for a maximum of five business days for review• Appointments should be scheduled <br /> actorngy. y not be Immediately available for review. Anew <br /> 3, A file at is active) being worked on by EHD staff may <br /> appiic�tion may be submitted when the fits)s available. <br /> Ileank mayrequire a$93.00 deposit prior to review. <br /> q, Any fill 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 app <br /> 5, •'TEN*I7IVE appointment dates must be Confirmed with EHD staff. <br /> g. Applications received after 3:00 pm will be processed the next business day. <br /> EDATE <br /> MED APPOINTMENT DATE TIME <br /> NFIRMEDPHONEFAX INITIALSD YES <br /> NO REVIEW DATE <br /> ewo,sa�aoa <br /> ertaaor <br />