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Auz-09-04 Z1:41 From-TTI TETV `CH EM INC tS166520307 T-017 P.01/02 F-227 <br /> F:mP LOG 14UMBER <br /> DATE RECEIVED <br /> (� Sax.�OAQEJIN C4isNTx <br /> n i_I � W E© ENVIRONMENTAL HEALTH DEPARTMIF 4T <br /> 304 .E Wcber Ave 3`a Floor Stockton,CA 9520 <br /> AUG 1 0 -2004(209)44$-3420 Fax: (209)464-013S Weld: www.eo.s=-joaqu- ca.us/ehd <br /> 'E-Wii-luNNIENT HEALTH PUBLIC RECORDS RELEASE AAPPLICA FION <br /> APPLICANT' `-° ai �- �—�� l3USINE3SlAGENCY. kl�TQ <br /> ADDRESS: I L i N CA 1P C. tz- a V � ' <br /> PHONE•q�10~~g 53 �4b _FACSIMIL�: <br /> TENTATIVE'APPOINTMENT DATE: Time:, � <br /> (Pleas®aliow i a Dasinass da75 from data Of applicaUan 50mi 1) <br /> M CHECK BOX TO WOPITF REQiJEST-#33-oo FEE—wQur;sT PROLE D IH 3 SINF.SS D Y5 <br /> SIGNATURE OF APPLICANTDATE <br /> DeparurAl use only <br /> ADDRESS UNIT <br /> i z z F. W e- A,v E. 6-1-0G`� - q unit 1 <br /> suds 3 c q unci 2 <br /> s 3 ,. ca 6 1 <br /> s. sues, h <br /> ca <br /> r.�:- <br /> t --.S. �tFIL C 35 U <br /> FL sem, S. L-,A) I-Aj AC,:f c.ot Z4hW f <br /> a M Fn'A- L D. 1.4/� 1.. 35 44)na 5 <br /> t0. Slieac A QJ G. i�rr C., TK 35 - - <br /> ENVIRONMENTAL HFAl-Tit DEPARTMENT FILF- <br /> UNDERGROuND TANK(UST)CLEANUP SITE(LOP) Q houSING ABATEMENT n.S0 0 WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) » FOOD FACIEITY M SO D WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG tcENNEL C3 D Y <br /> HAZARDOUS WASTE GENERATOR A CHicKt N RANGti Q PK TREATMENT PLANT <br /> Gl TIERED PERMITTED FACILITY I-3 MOTlrtjnQTEL n PU PERTALICKNAIF1CHEM TOILl;1S <br /> A TAT74o>iiOpY PIERCING POQt15PA C7 p USE APPiaCATiQri 51TES <br /> C1 MEDICAL WASTE FACILITY © OTHER{PL�E£PECIFY) <br /> 1, List up to ten addresses in the space above. Select the tyPe(S)of files f lom the list above by checking <br /> the appropriate bax(es)- At least one file typo MUST be selected. Fax t 209 46"138 or mail to the <br /> address indicated above. <br /> 2. F-HP will notify' applicant if any EHD files exist. An appointment for -eview will be confirmed <br /> approximately five business days but no later than ten(10)days after rc ceipt of application. The files <br /> will be held for a maximum of five business days for review. Appointm4 nts should be scheduled <br /> accordingly. <br /> ' 3. A file that is actively being worked on by Iw1-I1)staff may not be immedia ely,available for review. A new <br /> application may tm submined when the file is available. <br /> a- Any file not returned in the same condition as released will be reorganii W by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require 1$93.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirme4 with FHD staff. <br /> 6. Applications reee"Ived after 3;00 pm will be processed the next busines day- <br /> CONF(RMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONI= FAX INlTIA1.,5 <br /> REAF.WED YES NO REVIEW DATE <br /> i <br /> �,oss-o�aue - <br /> anrtoua <br /> a.. <br />