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EPID LOG NUV,21: <br /> SAN JOA(7UIN COUNTY <br /> ENVIRONME NTAL REA.LTH DEPA.R71MENT <br /> L;1w L., 2 1 x.005 304 E Wcber Ave 3d:loos Stockton, CA 95205 <br /> ,F <br /> L.. ipl)463-3420 Fax: (209) 464-0138 Web: w-%-w.co.san-joaquin.ca.us1ehdZ -71 <br /> ENVIRONPOIEIIJ: H: <br /> P EER',il,1T/mo'1 ' <br /> PUBLIC RECORDS Rl-eLEASE APPLICATION <br /> APPLICANT: )kwq__15USINESSIAGENCY: <br /> ADDRESS. qoz- -Z'a&m±_a - IL — <br /> 9i" n+_ <br /> PHONE. da FACSIMILE: 265 1q22 <br /> TENTATIVE"APPOINTMENT DATE: Tirno- 8LN4 <br /> (Please allow 10 business days from date of applicztIon submittal) <br /> CHECK 13OX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> - <br /> SIGNATURE OF APPLICAN DATE 12JP5 <br /> T 0Gr,2FtMPr',t Use 0MY <br /> FILE ADDRESS UNIT <br /> 1. Svrrt aa_!�� 4{v Ave 0 1 171 Unit 1 <br /> Suer.( �Aab f-1WC1rACL &48'_ cly. <br /> 3. Stmrl .1 1 n-�e-.r.1 go -V A 50 1� 0 Unit 2 <br /> 4. StreetSO&L cl� <br /> s. stmt coo 35 Qjet-o\&AJnit 3 <br /> 6, sleet vo.'Arr kv q G 35) �)e <br /> C;rly -;i ��' 7 Unit 4 <br /> kt)o _1ly_____"� <br /> 9. street Ci ❑ Unit 5 <br /> io, street IV <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> S/UNDkRGROUND TANK(UST)CLEANUP SIT5(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE;FACILITY <br /> UP:(OTHER CLEANUP SITE(NON-LOP) 1:1 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> l3dT,UNDERGROUND TANK(MON ITORINGIREMOVAL) ZI DOG KENNEL 0 DAIRY <br /> W, AZARDOUS WASTE�GENERATOR 0 CHICKEN RANCH 0 FKG TREATMENT PLANT <br /> :1118riERED PERMIT-i-ED FACILITY C3 C1 0 PUMPER TRUCKtYARDICHEM TOILETS <br /> 0 TATTOO/BODY PIERCING to P001JSPA 0 LAND USE APPLICATION SITES <br /> 1:3 MEDICAL WASTE FACILITY C3 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list'above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHID files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The file., <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. 4 file that is actively being worked on by EHD staff may not be immediately available for review. A ner <br /> application may be 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 <br /> of the applicant. Future file revievis by the store applicant may require a$93.00 deposit prior to reViE� <br /> 5. 41 ENTATIVE appointment dates must be con9rmed with EHO staff. <br /> S. Applications received after 3-00 pm will be processed the next bUsinOSS.day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONVIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DAT E <br /> EMP 42-014W <br />