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Apr-30-04 10:51 am From-I:ordon Z roes T-818 P.002/003 F-333 <br /> r. EGE r • EHD LOG NUMBER <br /> 's �li �. SAN JOAQU q COUNTY <br /> � <br /> ENVIRONM);NTAL HEALTH DEPARTMENT <br /> APR 3 0 20(gg8 304 E Weber Ave 3d Floor Stockton, CA 95205 <br /> 9)468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us1ehd jq <br /> i`ViRO`JMENT HEALTH <br /> PERMIPUBLIC RECORDS RELEASE A-PPLIC <br /> QA <br /> nTION <br /> ' ' n <br /> APPLICANT: Q>0L'?In SbOWalkp—lp BUSiNESS/AGENCY: GOr On dC ,teS L_L_T <br /> ADDRESS: <br /> (_�r0\ hl . 6,roaJvJU Su t� kco00 San tD;ep C lk(( R-A tot <br /> PHONE: yU "l• cog 10 , (9?00 FACSIMILE: (4% • 7I` -`T <br /> TENTATIVE'APPOINTMENT DATE: (Calk w1e.) ,w_Twne: <br /> r <br /> (Pease allow 10 business clays from data of application sut m.ccar) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> I. S. \3 Sh w Voad Chya <br /> . 5: S ❑ Unit 1 <br /> : Cft <br /> a. swa of Ge. cn <br /> a 6oael t — 2 — 42 [I Unit ,�'(7� <br /> s. suer CRY Unit 3h� <br /> Saee1 <br /> 7. Sbee <br /> nit 4 <br /> S Svem aty <br /> 9. 9wet ❑ Unl <br /> 0. Svee <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 1:1 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> _JPr OTHER CLEANUP SITE(NON•LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> +nrHAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOIaODY P1FRciNG 0 POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WA5TE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 Or mail to the <br /> address indicated above. <br /> 2. EHO 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 (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 is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant Future file reviews 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 /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> dennw <br />