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AUG-23-2004 15:51 CC' -PR EARTH TECH 209 532 0773 P.01/0' <br /> DATE RECE]VED EHD LOG NUI R <br /> Ou. SAN 30AQ>LT7�t COYTN�'X <br /> R+N V]RONMENTAL HEALTH DEPARTMENT <br /> 3 2004 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> ? 468-;420 Fax: (209)464-0138 Web: www.co,san joagWmca_us/ehd b'07 <br /> E.NVIR���SERVICES <br /> UBLIC RECORDS RELEASE APPLICATION <br /> APPUCANI': oustNESSlAGENCY: <br /> ADDRESS: )� -0A,4 <br /> PHON" ! FACSIMILE <br /> TEM7A71V ' APPOINTMENT DgTE Q,14 Tlme: J) " <br /> (Please allow 10 business days from date ofappllcadon submittap <br /> Q CHECK BOX TO EXRmfTE RE UEST-P3.00 FEE--REQUEST PROCE3$ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTDATE 0-5 <br /> Department Use Only NOW <br /> FILE ADDRESS UNrr <br /> z. so-recj O 1Xd 1I 5 T P& <br /> F� <br /> ✓ z sem 11 Unit 1 <br /> ,✓ 3. str� 00 EL I2pbo y Unit 2 <br /> �'✓ s. s 6 ON <br /> Unit 3 <br /> ,/ 7. ftu 57 Unit 4 <br /> suaec L CM i 9y�- ti <br /> ✓ s, sin aro =�V <br /> D ❑ Unit 5 <br /> +o. suee� A <br /> 0 <br /> ENVIRONMENTAL HEALTH DEPi4PONTUFILE57 Un <br /> UNDERGROUND TANK(U5 r) LEANUP SITE(LOP) M HOUSING ABATEMENT G2 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON- Op) L Ll FOOD FACILITY Or som WASTE vEmcLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) D Doc KENNEL a DAIRY <br /> HAZARDOUS WASTE GENE OR Q CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERIUITTED FAC 13 MOTELJNOTEL ❑ PUMPER T'RUCKIYARDICHEMI TOILETS <br /> O <br /> TA PIERCING A POOLISPA k�LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY D OTHER(PLEASE SPEC4M <br /> 1. List up to ten add asses in the space above. Select the type(S) of files from the Ust above by Gherkin. <br /> the app nate b x(es). At least one file type MUST be selected. Fax to(209) 464-0138 or mail to the <br /> address i tldicate above. <br /> 2. EHD will wtlfy th applicant if any EHp files exist An appointment for review will be confirmed <br /> approxlm Lely fivo business days but no later than ten (10) days after receipt of application. The files <br /> will be he d for a aximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file the is actively being worked on by EHD staff may not be immediately available for review. A ne <br /> applic�tl n may be submitted when the file Is available. <br /> 4. Any file n t returned in the same condition as released will be reorganized by E.HD staff at the expens <br /> of the ap licant_ Future file reviews by the same applicant may require a$93.00 deposit prior to•revie' <br /> 5. 'TENTAT appointment dates must be confirmed with EHD staff. <br /> 6. Applicati ns rece` ed after 3:0D pm will be processed the next business day. <br /> CONFIRMED AP OINTMENT DATE TIME <br /> DATE CONFIRMED PHOW FAX INITIALS- <br /> REVIEWED YES NO REVIEW DATJ <br /> TOTAL P.O: <br />