Laserfiche WebLink
TERRACON - RENO Fax:775-351-2423 Nov 4 2003 13:47 P.01 <br /> t-'li ,J ��� l SAN IJOAQUTN COUNTY EHD LOG NUMBER <br /> NOV 0 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> FNVIRONNIEN�,WP�6'0$-3420 Fax: (209)464-013$Web: www.co.san-joaquin,ca.us/ehd <br /> PERW1/SERVECES <br /> PtiBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: C7 MQkE E' BUSINESS/AGENCY:B IZ�GO1� <br /> ADDREss:13 8O 62EcS s7 -# 233 S PSS fad <br /> PHO 5I �2�{od FACSIMILE: —1'�S-3S(- 2tlL3 <br /> TM <br /> ENT DATE: _CLlC�A- MCV 1-1 Tim.: a� <br /> (Phase allow 10 business days from date of application submittal) <br /> CHE K BOX TO EXPED REQUEST-$93,00 FEE–REQUE3 PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT (,t} <br /> DATE (( `f O <br /> Department Use Only <br /> FILE,ADDRESS UNIT <br /> r. slit Ob S. S '(, <br /> BtreN v31 P R S-i. G �T o E Unit 1 <br /> CI <br /> Unit 2 <br /> s. sc o 2 W Al_ni`TE S T. c; I I 9 r <br /> �. MA , <br /> 7. Sll . , . �C.i <br /> 2 S O 5'L city Il <br /> Unit 4 <br /> nit �Zl <br /> 5 � <br /> _/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ©:1I DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT t°7"SO4(D WASTE FACT <br /> HER CLEANUP SITE(NON•LOP) 4 FOOD FgCILITY ❑ SOLID WASTE VEHI <br /> JDERGROUND TANK(MONRORING(REMOVAL) 0 DOG KENNEL ✓".s' dti' � <br /> P� � DAIRY <br /> ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> IERED PERMITTED FACILITY O MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING d POOL/SPA E3 LAND USE APpLtCATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 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 dlcat ab ve. <br /> 2• 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(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 /> [REVIEWED <br /> ONFIRMED APPOINTMENT DATE II-I �. r <br /> TIME <br /> ATE CONFIRMED PHONE FAX INITIALS <br /> YES NO REVIEW DATE <br /> EHD aea�ocs <br /> sisrmoa 1�-`�-£>� /l���0�CLI`P55 Gi;✓' (,f') c�--Lvc-(.C�s7�t,� ��(�� "i.105�'S f-c�' .�`t'SS� 5 �7 SG G:(.N.G7-}f <br />