Laserfiche WebLink
NOV.19'2004 11:28 191526377 Yaron and Associatez #3545 P.001/001 <br /> • <br /> 11/15/2004 10;44 4640130 - - - - EWIPOWENTAL }£ALTH PAGE1 02 . -- <br /> DATE RPCEIVED rn <br /> 7 <br /> � OA.QUIN COVM END LOG N <br /> D SAN J UMBER <br /> a l ]ENVMOyMENTAL REALTH DEP RTmENT /// ]]] <br /> N 0 V 19 004 304 E Weber Ave 3"d Floor Stockton,CA 95205 t / <br /> J004 <br /> 468-3420 Fax: (209)464-0138 Web:www.co.san joaquin.Ca-us/ehd 2 X16 f <br /> EIvViRONMENT HEALTH <br /> VICES llPUBLIC RECORDS RELEASE APPLICATTON <br /> APPLICANT; i f `/ fWl� BUSIN/ESSIAGENtC-Y• �rCn `- SS�'C"/d 1Z-< <br /> ADDRESS 7� CR �. Zo;�) ,H �y.(*� 'T yA} <br /> PHONE: t l CP S O ' k j 2 <br /> FACSIMILE:. <br /> TENTATIVE"APPOINTMENT DATE: Jy� �01- ,Tim.: loo q- <br /> �-1 (Pls;.o I111o+r 10 business dim Man dato of.ppa=Uoe Wbmleal) <br /> u CHECK BOX To EXPEDITE REQUEST.$2100 REQUE OCE ED BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 'l b� 'L (s DATE 11 f�/ 1 <br /> 0000,tnent Use Only <br /> FILE ADDRESS UNIT <br /> (/(-✓1 .(2-. moi' C t.'' a <br /> ❑ Unit 1 <br /> asoma Q Unit �p <br /> s U \\��D <br /> .. <br /> rUnit 4 <br /> a. swe <br /> Q Unit 5 <br /> Io <br /> ENVIRONMENTAL HEALTH DEPARTMENT FOES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) tl HOVSfHG ABATEMENY D SOW WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) M FOOD FACILITY O SOLID WASrE VEHICLE <br /> UNDERGROUND TANK(MONITORWGIREMOVNa 13 DOG KENNEL EI DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCN tl PKo TREATMENT PLANT <br /> 13 TIEREDPERMrTTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS_ <br /> -0 TATTOOIBODY PIERCING tl POOL/SPA <br /> 13 MEDICAL WASTE FACILITY CKOTHER(PLEASE SPACIFY) t142, (pT MPJ,1�A'1'�Ut7 <br /> �'I tP5 l��) /uf•L-1 <br /> 11 List up to ten addresses In the space above. Select the type(s)of files from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 1209)4640138 or mail to the <br /> Address Indloated above_ <br /> 2. EHD will notify the appllaant If any EHD files exist An appointmentfor 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. Appoldtments should be schoduled <br /> accordingly. - <br /> 3. A toe that is actively being worked on by EHD staff may not be immediately avallable 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 feorganb:ed by EHD staff at the expense <br /> of the appricanL Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> S. "TENTATIVE appointment dates must be confirmed With EHD staff. <br /> G. Applications received after 3:00 pm will be processed the next busine=ss day. <br /> CQ,NFIRMED.APtSOINTMT.DATE.;-___�. _ TIME . " <br /> DATE CONFIRMED PHONE FAX lNtT1)1LS. <br /> REVIEWEU YES NO REVIEW DATE <br /> Nexov <br />