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07_/08/2002 MON 12;50 FAX 916 5654356 0. uulaul_ <br /> .e rr Ciel Sao[ iq:ve r L"dli ENVIRONhENTI =ALTH PAGE el <br /> w � AN JOAQUIN COUNTYPU13L.IC HEALnH SERVICES � 4MD a KUMaEJ <br /> II ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,,THIRD FLOORLOOk <br /> I / <br /> STOCKTON CA 95202 <br /> (209)463-3420 <br /> PUBLIC RECORDS RELEASE APPLICAMN <br /> APPLICANT L:977fc�x!✓l , / , r., J RUSINPSSIArFNCYyjfHAuJ r✓c•,o� �,� �, . <br /> ADHESs /3 zr .r> ,c%a..r �•�•�� 5",Y� �'.r9- 9ssias! .. <br /> PHONE n n- FACSIMILE j/G-54-s-435 <br /> �-TENTATIVE`APPOINTMCNT DATE TIME <br /> Co (Plesso give T f i s apPll submittal) <br /> ❑ I <br /> CHECK BOX TO EXPEDITE REQUEST- .00 F - UST OCES C INES$DAYS <br /> f'SIGN(7IURE OF APPLICANT DATE _72AZI2, <br /> Ci <br /> FILE ADDRESS THIS SIDE CHO STAFF USE ONLY <br /> PROGRAMALEMENTS SEARCH <br /> Z1 95 <br /> .W <br /> N J S 6 <br /> 1 IF <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Uf UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ARATEMERT D SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ $OLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> IR HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANck ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMrrrFO FACILITY D MOTELrHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOMODY PEIRCING ❑ POODSPA Cl LAND USE APPLICATION SITE$ <br /> ❑ MEDICAL WASTE FACFL ❑ PUBLIC WATER SYSTEM o OTHER(PLEASE SPECIFY ABOVE) <br /> 1, List up to tan addresses in the space above. select the type(s)of flies from the list above by Checking <br /> the appropriate box(es). At least one file typo MUST be selected. Fax to(2091464-0138 or mall to the <br /> address indicated above. <br /> 2- EHD Will notify the applicant if any EHD flies exist, An appointment for review will be confirmed <br /> apprOXinlately five 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 new <br /> application may be submitted when the file i$available. <br /> 4. Any file not returned in the same Condition as released will be reorganized by EHD Staff at the expense <br /> or the applicant. Future the reviews by the same applieant tray require a$89,00 deposit prior to review, <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 PHONIC FAX iNMALS <br /> REVIEWED YES NO <br /> m nisnr � ' <br /> Post-le Fax Note 7671 °q°"7 rL aip°IosE <br /> To From <br /> A <br /> COJDaPL °' "Go E r <br /> Phone x Le� G k- Zd <br /> �.C/_ F" 7.0 f f o 3 <br />