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AUG -26-2009 11:40 <br />DATE RECEIVED <br />F <br />From: To:12094640138 <br />0 0 <br />AN JOAOUIN <br />Page: 1,'I <br />F%mum ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />APPLICANT: BUSINESS/AGENCY: J -±Muse <br />ADDRESS: - CITY/STATE/ZIP:K oyw A-0 A <br />PHONE (1): - PHONE (2):(YO8 u22-2 qZL FACSIMILE: Cq�S- g37—'7227 <br />TE TA /VE* APPOIN MEN T DATE: ext , I Time: rp Ar✓l <br />(Please allow 10 business days from data oapplication aubmi al - "Tentative only - must be confirmed) <br />Q CHECK 13OX TO EXPEDITE <br />Electronic Information: 0 List U :._ r:_ <br />criptloo <br />OR CHECK ONLY) - REOUEST PROCESSED IN 3 BUSINESS DAYS <br />1 DATE 123/11 <br />FILE ADDRESS <br />EHD USE ONLY <br />.. ne9r <br />unit 1 <br />to <br />Street # <br />Street Name <br />city <br />SOLI) WASTE FACILITYIVEHICLE <br />F <br />OTHER (NON -LOP) <br />e <br />AIR I, <br />,g <br />__ �'t0" 2 <br />Y! ✓ 0 - _ nit 2 <br />2. <br />UNDERGROUND TANK (MONITORINGIREMOVAL)D�_ <br />❑ DOG KENNEL <br />3. <br />HAZARDOUS WASTE GENERATOR <br />M CHICKEN RANCH <br />Unit 3 <br />4. <br />S. <br />_ _ --- <br />D Unit4 <br />6. <br />7. <br />Q- <br />.. <br />tJf �fi <br />9. <br />10. <br />_ _.. <br />........___ <br />D Unii B <br />—91 <br />Specifie Date Range of Information RegUGBted: From <br />to <br />ENVIRONMENTAL <br />Q UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />[� CLEANUP SITE <br />HEALTH DEPARTMENT FILES <br />❑ HOUSING ABATEMENT] <br />SOLI) WASTE FACILITYIVEHICLE <br />F <br />OTHER (NON -LOP) <br />❑ FOOD FACILITY <br />Q WASTE TIRE <br />UNDERGROUND TANK (MONITORINGIREMOVAL)D�_ <br />❑ DOG KENNEL <br />Q DAIRY <br />HAZARDOUS WASTE GENERATOR <br />M CHICKEN RANCH <br />❑ WASTEWATER TREATMENT PLANT I t <br />Q TIERED PERMITTED FACILITY Q MOTELIHOTEL ❑ PUMPER TRUCKiYARDICHEMiCAL TOILETS <br />E] TATTOO/BODY PIERCING ❑ POOLISPA Q LAND USE APPLICATION SITES <br />❑ MEDICAL, WASTE FACILITY ❑ COMPLAINT RECOR136 ❑ OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 6:00 AM-5:00pm (EXCLUDINQ HouDiAYS) <br />1. List up to ter.Laddwses in the space above. Select the type(s) of files from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. Fax_to-(20Q 464-0136 or mall to the address indicated above. Address <br />ranges will not be accepted - for additional assistanos with file addresses, contact the EHD. Applications received after <br />3:00 pm will be processed the next business day. <br />2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br />days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br />should be scheduled accordingly. <br />3. A file that Is actively being worked on by EHD staff may not be Immediately available for review. A new application may be <br />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 of the applicant. <br />Future file reviews by the same applicant may require a $125 deposit prior to review. <br />