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\ 11/25/2003 16:12 2094670 - AGE STOCKTON PAGE 01/E V DATE RECEIVED W n EHD LUG NUMBS nE"E� E 0 ]E r� rrrAL HEALTH DEPARTMMNT NOV 2 5 20 Z 304 E Weber Ave Td Floor Stockton, CA 95205 109)468-3420 Fag:(209)464-0138 Web: www.co.san-joaquin.caustchd ENVif-AHENT HEAL[i-i cEr-; , a Lr E.S PUBLIC RECORDS RELEASE APPLICATION APPLICANT: BUSINESS/AGENCY: _ _ ADDRESS �3l` `� / Va J LUt;K tD PHONE: a®7p r `7� !�j. !60 FACSIMILE: 6709 TENTATIVE*APPOINTMENT DATE: 3, Time: rAw EQI REQ G (Please allow 10 business days from date of application submittal) J CHECK BOX TO EXPEDITE REQU T-$93.00 PEE-RE U T CESft IN 3 U (NESS DAYS SIGNATURE OF APPLICANT DATE Department Use Only u ✓ t FILE ADDRESS UNIT Street 2_ MM Aid /� /� y� C1 [� Unit 1 . ` SI .Q f r 3. sheet a 2-- G 1 " ® Unit 2 4. Street 5. SlrgM e CI c 6. Street G , Unit 3 7. siro®t 1 t o Unit 4 Y/!/ 8, street h C s. sf.. t aty (] Unit 5 10. Street GMU L-3 r, tPt ENVIRONMENTAL HEALTH DEPARTMENT FiLES � �4 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING A13ATEMENT ❑ SOLID WASTE FACI OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE UNDERGROUND TANK(MONITORINGIREMOVAL) C3 DOG KENNEL '❑ DAIRY HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKC,TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKfYARD/CHEM TOILETS ❑ TATTOOIBODY PIERCING . © POOLISPA C3 LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-013a or mail to the address indicated above. 2. EMD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10)days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that IS actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file Is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$93.00 deposit r r iew, 5• *TENTATIVE appointment dates must be confirmed with EHD staff. 6• Applications received after 3:00 pm will be processed the next business d 01, .,. . r'„ -A CONFIRMED APPOINTMENT DATE _ TIME DATE CONFIRMED PHONE FAX', INRIALS REVIEWED YES NO REVIEW DATE T EHD 48-02-008 e►e/Z803