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_05/24/04 MON 12:20 FAX 92529993 SECOR SF 0 <br /> 05/2412004 10:32 4640138 ENVIRONMENTAL HEAL PAGE 01 <br /> t:HU LUU NUMUIZI <br /> DATE RECEIVED (] SAN JOA. COUNTY <br /> y f V/ ENVIR® NTAL DEPARTMENT <br /> "E�E�\J E D 304 E Weber Ave 3'dFloor Stockton,CA 95205 <br /> MAY 2 42 �#68-3420 Fax: (209)464-0138 Web.www.cc.san-joaquin.ca.us/chd <br /> ENVIRONMENT HEALTHPUBLIC RECORDS RFLEASE APPLICA17ION <br /> APPLICANT:_ CL-I.-/` JJ01-S BUSINESS! CY. <br /> ADDRESS- S7 !✓Tt� Cc-�-�— <br /> 7-- <br /> HONE l L 9 `Y3® ° FACSIMILE:Z-?Q <br /> TENTATIW APPOINTMENT DATE: Time: <br /> (please allow 10 baseness date of application submItW) w P <br /> ® CHECK BOX TO EXPF-RITE REQUEST- 9 o FEE—REQUEST PROCE33SD IN 3 BUSINESS DAYS ` <br /> SIGNATURE OF APPLICANT rl/� DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> °l ' 13 Y ❑ Unit 1 <br /> Mr- <br /> i, sty UST <br /> 3 tJ it2 � <br /> �. creat Uni :. r <br /> s. r� <br /> s. Stmet d <br /> 7 Unit 4 <br /> a. Brest i t i [ ❑ Unit 5 <br /> 9, Beet <br /> A <br /> 10. Wred <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> OP ® tIOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> UNDERGROUND TANK tUST)CLEANUP SCTE(LOP) `9%-F FACILITY ❑ SOLID WASTE VEHICLE _ <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ DAIRY <br /> D UNDERGROUND TANK(MONITORINGMMOVAL) ❑O DOG CHICKENRANCH ❑ PKG TREATMENT PLANT <br /> pl,HAZARDOUS WASTE GENERATOR ❑ MoTELiNOTEL ❑ PUMPER TRUcKlyARD/CHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY p pOQUSPA p LAND USE APPLICATION SI'T'ES <br /> O TATTOOIBODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> MEDICAL WASTE FACILITY / <br /> 1, List up to ten addresses In the space above. Select the type(s)of files from the list aboye by checking <br /> the appropriate box(es). At least ane file a MUST be selected. Fax to(2021464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD fil®s exist. An appointment for review will t of application. The files <br /> approximately five business days but no later than ten(10)days afterrerits should be scheduled <br /> will be hold for a maximum of five business da for.review. APP <br /> tme <br /> accordingly. <br /> 3. A file that Is actively being worked on by 1EHD staff may not be immediately available for review. A new <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 review's by the same applicant may require a$93.00 deposit prior to review <br /> 5. 'TENTATIVE app®intmant dates must be 6onfirmed with END staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> ONE FAX '•1NITIALS ' <br /> DATE CONFIRMED ; <br /> REVIEWED _ YES NO REVIEW DATE <br /> eta2o0s <br />