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x,01/07/2004 WED 14:30 FAT 2002/002 <br /> VAI U f I LUU4 14:pp ti ..moo tl4V 11`�.JIVI"tt.N I F,� r'k:HL I h t-Alit bl <br /> DATE RECEIVfiD bnu Lw II..I� LIvh <br /> �o SAN JO.A.QUIN COUNTY <br /> Lel L���I" ! I'N iRONm ENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'-d Floor Stockton,CA 95205 <br /> JAN 0 7 2001 (209)468-3420 Fax: (209)464-0138 Web:avww.co.san jvaquirLmus/ehd <br /> �NVIr;U`Jivit'a i �L 1 PUBLIC)RECORDS RELEASE AI'PLICAUON <br /> APPLICANT ",H "ii �E� Bt7SINES3/AG£NCY 'S/C iTDCIf{1 ES <br /> ADDRESS: //`l Iry a STi� .4KsS�l E <br /> PHONE; 66/) a7- ,11 FAcsIMILE: !/ <br /> TENTATIVE*APPOINTMENT DATE: ///3 Q 7 Tame:_11-166 <br /> r' (Please allow 10 buslnass days from date of aPPQCaBon submittal} -T <br /> �OCK7tj 7ucsDitY <br /> //310 <br /> CHECK SOX TO EXPEDITE REQUEST•$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Departrnent Use Only U <br /> FILE ADDRESS UNIT <br /> suee+ d5 SjaG D Unit 1 <br /> a s AIf a Unit 2 <br /> IfR I <br /> s, sae. x 500 <br /> AIAVV m [3 Unit 3 <br /> a. sa.et 4�0 f �4lf R. 4— <br /> s,m,t / ILL-/E LE IS a e - Unit 4 <br /> e. stwt /310 zSLTe>A) vc- <br /> nit 5 <br /> / ENVIRONl1i( WAL Hf:A1.TH DEPARTMENT FILES <br /> Lf " ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE VEMCI:ACILE " <br /> ; OTHER CLEANUP SRE tNON-LOP) p FOOD FACILITY Q SOLJD WASE VEFi1CLE <br /> 0 UNDERGROUND TANK(MONrr0R1NGAF EM OVAL) Cl DOG KEW4EL C3 DAIRY <br /> a HA ARDOUS WASTE GENERATOR M CHICKEN RANCH O PKG TRFATMENT PLANT <br /> ❑ TIERED PPltM11TE0 FACILITY f7 MOTELIH0TEL M PUMPER TRUCKIYAPDtCHEM T0i1.ETS <br /> 0 TIERED EMI "TED FA 1 O POOLISPA 0 LAND USE APPLICATION SITES <br /> t] MEDICAL WASTE PIERCING <br /> O OTHER(PLEASE SPECIE n <br /> 9. List up to ken addresses in the space above. Select the type(s)of fibs from the list above by checking <br /> the appropriate box(es). At least ane file type MUST be selected. Fax to(2091 4s4-013S or mail to the <br /> ad rots indicate a oye. firmed <br /> 2• EHD will notify the applicant if any EHD files exist. An appointment e reavi et of ll be tion The files <br /> approximately five business days but no later than ten(10)days errshould be scheduled <br /> will be held for a maximum of five business days for review. Appointments <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. 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 expens <br /> of the applicant. Future file reviews by the same applicant may requlre a$93.00 deposit prior to revie <br /> 6. *TENTATIVE appointment dates must be confirmed with END staff. <br /> C. Applications received after 3:00 pm will be processed the next business day. <br /> GONFIWED/ poiNTMENT DATE TIME <br /> bATE GQNFlRM>~u <br /> 'PHONE FAX'' VMS <br /> REVIEWED YES NO REVIEW DATE <br /> a a <br /> EMD 4302.606 <br /> �ISfIA03 - <br />