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11:;28/2004 13:24 FAX 209 9480 191003 <br /> pr.y tivv..v.•wu. <br /> DATE.RECEIVED ^ SAj1j,Td V OAQUIN COUNTY <br /> �' 0NMNTAL :&Lry+H E'PAR <br /> 304 r Weber-Ave 3'd Floor Stockton.,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:www.co.san-joaLqum-caus/ehd. <br /> pURLIC ,CORDS RFLEASE-APPLICATION <br /> APPLICANT: �,r. Jc �v� BuslNEssrAG�tCY: (�� ( " <br /> ADDRESS:_ a� Y�'t GM�J f F(� vim' Ltc�ttt►Ta <br /> l T1 s FACSIMILE: R�q -o&91 - -- <br /> PHONE: ______7— <br /> IVE` <br /> TENTATAPPONTMENT DATE: l�j Time: / :a✓ <br /> (Please allow 40 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST 493.00 FEE-REQUEST pp.00FS$ED IN 3 BUSINESS DAYS ^l <br /> SIGNATURE OF APPLICANT l ( '�✓�. ®ATE <br /> Department Use Odd <br /> UNIT <br /> FILE ADDRESS <br /> 12-. <br /> 6 [ p Unit 4 <br /> H tut WL t�d'aa�. tin r fo„ Unit 2 <br /> 4, Vnd ANA&a—saa �kfw. Unit 3 <br /> _ ,......,� 5 Shed <br /> s. sueec <br /> _-,_. r. see Un1t4 <br /> a. <br /> Unit 5 <br /> 9. sired <br /> ,o, Shed <br /> ENVIRONMENTAL HEALTH OF-pARTmENT FILES <br /> 40 SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT <br /> is OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY C3 SOLID WASTE VEHICLE <br /> 1% UNDERGROUND TANK(MONn-mNG/RI:MOVAL) ❑ DOG KENNEL t� t7AlRx <br /> co <br /> ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 1. PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ® PUMPER TRUCK(Y EM TOILETS <br /> 3 TA ODY PIERCING ❑ PA 61L LAND USE APPLICATION SITES <br /> C3 MEDICAL.WASTE FACA�Y ® OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above oy checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0438 or mail to the <br /> address indicated above- <br /> 2. EHnotify the applicant if any EHD files exist An appointment for review will be confirmed <br /> D will <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 fere 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 aval ble for review. A new <br /> application may be submitted when the file is available. rise <br /> 4. Any file not returned in the same condition els released will be reorganized by EHD staff at the expe <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review <br /> S. 'TENTATNi"appointment dates must be confirmed with EHD staff. <br /> S, Applications received after 3:00 pm will be processed the next business day. <br /> IR n <br /> P61NTMENT DATE '`r TIM E �a• <br /> ATt;•troNFIRNIED }..PHONE • FAX'; , ?ti Ntf' S <br /> �7 <br /> REV( •ED YES 410 REVIEW DATE: <br /> UM 0.92,006 <br /> 67&2001 <br />