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`j FROM :Sau San FAX NO. :510-436-4780 08 2003 08:23AM P1 <br /> 09�05/20a3 <br /> 11:01 46001, ENVIRONME14TAL HEr�l.lr1 P4C-,E a2 <br /> �� � ) EHD LOG NUMUCR <br /> `� --- SAN JOAQUIN COUNI'Y <br /> SEP 0 8 2003 F,IwIRONMENTAL MALTI-T DEPARTMF.N'1' <br /> 304 E Veber Ave 3"Floor Stockton, CA 95205 <br /> 209)468-3420 rax: (209)464-0138 Web: wtiW✓.co.sanjoagVin.ca.us/chd <br /> ENVIRUNfV1ENT iiEALT JqJ3 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION _ <br /> -jam� c n...� � q�- <br /> APPLICA145'� JT1 ►'- d,,UQQS1N1E/S iJAGENCY: �r 1J'IC� <br /> ADDRESS: 1J Y`r/� 1 ��VC%{ �j �Y i <br /> PHONE:5)Q ��Z10 l e-[1gC51MILL: <br /> 5— S -�fo-7q v�ice� <br /> TENTATIVE-APPOwTTML! TDATE= lime ` 1- <br /> (Plsaza allow 10 business days Rom dnte of applirat on submittal) <br /> l-� CHECK COX TO FaXPEOITE RE -59s.tso F :-REQUE5r PROCESSED IN J SUSINES3 DAY5 O i <br /> SIGNATURE OF APPLICANT ___ __ DATE <br /> Oaoartmort Use Only <br /> FILE AnD S UNIT <br /> 3 �57-77 <br /> C] Unit 1 ' <br /> CII <br /> -- aY _ --- Unit <br /> I- Vitt _ Unit 4 <br /> ❑ Unit 5 <br /> r <br /> ENVIRONMENTAL HEALTH oEPARTMEr4T FILES <br /> }UNDERGROUND TANK(UST)CLEANUP BITE(LOP) 0 HOUSING ABATEMENT ClSOLIO WASTL•FACILITY <br /> Q OTHER CLEANUP SITZ!(NON-LOP) O FOOD FACILITY 0 sOLto WASTE_VEHICLE <br /> if, UNDERGROUND TANK(MONITORING:REMOVAL) C 003 KENNEL CO OAIRY <br /> HAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH O PKG TREATMENT PLANT <br /> G TIERED PERM1gED FAGILfTY O MOTELIHOTEL ❑ PUMPER TRUCK[YAROICHELI TDILETS <br /> O TATTOO/BODY PIERCING M pOOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WA5tE FACILITY Q OTHER(PI.�SE SPECtFY) ,._—. -•- <br /> 1. List up to tan addrv6¢as In the space above. Selact the type(S)of files from the list aboYe by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-QI30 Or Madl 10-fte <br /> actrtrrs5 ipdiCdjed above. <br /> 2. EHID will notify Ute applicant if any EHD files exist. An appointment for review will be cnnfirmad <br /> approximately five busines3 days but no later than ton (10) days after receipt of application. The files <br /> will be held fore maximum of five business days for review. Appointments should bo sch@duled <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 roloaLeQ will be reorganized by P-HD staff at the expense <br /> of the applicant. Future file rtivlews 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 /> g. AppiicaUonS received after 3:00 pm will be processod tho next business day. <br /> CONFIRMED APPOINTMENT DATE Y TIME <br /> I DATE CONFIRMED PHONE FAX INITIALS <br /> REVI EWS0 YES NO T REVIEW DATE _ <br /> !ND N-0a+D• <br /> vaaeea <br />