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02/ 2004 10 : 04 916867. 'x '90 SECOR PAGE 02 / 0 <br /> 1 � 97. / 2004 15 : 10 464G... ENVIP.ONMENTAL _TH PAGE 01 <br /> j <br /> DATE McEIVEDIII LOG NUMBED <br /> PAIN, JOAQUIN COUNTY <br /> IRE 1h ,14 E, a VI-tNn� ENTAL HEALTH PEPARTMNT <br /> 304 E Weber Ave 3` 1 Floor Stockton, CA 95205 <br /> NO V 0 2 20K409) 468A3420 Fax: (209) 464, 138 Web : www.eosari juaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORAS RELEASE APPLICATION <br /> APPLICANT: rivi O -. HVSINESSiAGENCY; . 1U7' ince✓YILxgS — <br /> ADDRESS: JO]_� 1010f-e L'C'D - /�y <br /> PHONE: PLO- 801 � Ot{0 PACstmiix: LTJ U /\\ D 7777 & � ^ a-/ 7 o <br /> TENTATIVE" APPOINTMENT DATE: <br /> :rte <br /> (PIga.9� allow 10 business days from data of appiiw8on submittal) Is <br /> s �1 <br /> CHECK BOX TO EXPEDRE REQUEST IF $9933...00 FEEREQUESTPROCESSED W 3 BUSINM DAYS s <br /> SIGNATURE OF APPLICANT � �—�W— � DATE <br /> L_! Doom Nmarit Use Pn_ y <br /> FILE ADORES$ UNIT <br /> z i'on �v r CA QJS Sp n1 d1 <br /> s ! /- Unit 3 <br /> a 7 2 ow S /Vc"' e <br /> ji IT <br /> �UKd 4 <br /> s, Man 05 QrolJa R <br /> ' ' 9. succi S�7 ! L 1 ✓t � <br /> to, <br /> 9D7 LrNC ✓7 "oi S ju" <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ve <br /> 1 r <br /> ..W UNDERGROUND TANK (UST) Gi.E.ANUP SITE (LOP) 0 HOUSING A9ATEMENT M SOLID WASTE FACILITY <br /> M OTHER CLEANUP SITE (NON{OP) 0 FOOD FACRMY O SOUP WASTE VEHICLE <br /> I& UNDERGROUND YANK (NONITC4UN 12MOVAL) 0 DOG KENNEL 0 DAIRY <br /> YKHAZARDOUS WASTE GENERATOR O CHr.KENkMCH ❑ PKG TREATMENT PLANT <br /> d TIERED PERMnYED FA=rtr O MOTEUR01I CI PUMPER TRUCKIYARD/CHEM TOILM <br /> ❑ TATToMfJDYPIERCING o POOUSPA .Fsi" tANDUSE APPLICATION Sn' :S <br /> 0 MEDICAL WASTE FACILITY C3 OTHER (PL,FASESPECIFY) <br /> 1 . List up to ten addresses in the space above. Select the. type(S) of files from the IM above by checking <br /> the appropriate box(es). At least one file type MUST be se(aoted Fax to (209) 464a0f 38 0yA I the <br /> address IrtdNed above, <br /> ?.. EHD will notify the applicant If any EHD files exist An appointment for review will be confirmed <br /> approximately five business days but no later than ten (f 0) 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. Anew <br /> spplicat(on may be submitted when the fife is available. <br /> 4. Any file not returned in the same condition as released will be reorganTzed by EHD skaff at the expense <br /> of the appiNcant Future file reviews by the same applicant may require a $93.00 deposit prior to review <br /> ;f. "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 /> 17 <br /> �NFIF7MEIJ. .P? 4-61N' MI" DATE :' : : TIME ":;`,,:' k`.+a.n <br /> f)11fE COjSEI] RIEf3 PHONE PAR INIt`NALB <br /> REVIEW DATE . . .. :. <br /> F2EVIEINED ,. ' YES NO - <br /> t srm.a�a�zoas . <br />