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11/01/2004 12:10 FAX 209 9480r" Z002/002 <br /> (nor-7gtl�'k,�l,Dr�,'�� � SAN JOAQUTN COUNTYln� .I 11 U 'H DEPARTMENT <br /> ENYIRONPvIENTAL HEALTH <br /> NOV - 1 2004 304 E W ebeT Ave,3`d Floor Stockton, CA 95205 <br /> (209)468-3420 Fax-, (209)464-0138 Web;www.co.san joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE AYPLI�CATION <br /> APPLICANT: �C,^ tir��jJ�.---- BUSINESSIAGIiNCY: > >/P�rh=GtC <br /> ADORess' a�a� ��!/Ltv� p <br /> ter cA 95-,Z-0L <br /> PHONE: R/ wR- FACSIMILE: �Tq <br /> TENTATIVE'APPOINTMENT DATE: II/f V�oy Time_ <br /> (Please allow 10 business dAys from date of appllcation submittal) <br /> Q CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Deoarbnent Use Only <br /> FILE ADDRESS UNIT <br /> i. so-eetTi.i a 1 Lk f�YI LL4 d4�1 <br /> • ❑.. .Unit 1 <br /> ,. :mw <br /> o vl,l a ' otL�u -:; d1': - Unit 2 <br /> 4, Suer e �G G 510 41" <br /> Unit 3 <br /> 6. Sueel <br /> �. sweet <br /> Unit 4 <br /> a- serer <br /> 9. 54ec1 G Unit 5 <br /> Ia. so-ed � <br /> ENVIRONMENTAL HMTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT sL SOUD WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY D SOLID WASTE VEHICLE <br /> a UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL &DAIRY <br /> Z HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 9-PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY <br /> E:1MoTELA40TEL ❑ PUMPER TRUCKryARE)ICHEMTOILM <br /> Q TATTOOMODY PIERCING Q POOLJSPA LAND USE APPLICATION SITES <br /> o MEDICAL WASTE FACILITY ❑ 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 EHD 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 files <br /> will be held for a maximum of five 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 available for review. Anew <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 rile reviews by the same applicant may require a$93.00 deposit prior to review <br /> 5, *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3.00 pm will-be processed the next business day. <br /> :V H j• TIME % {:;'. ?r.''' r <br /> D.-APPOIh1TMENT. AT. "I'. .. " •:.,a ::. : ,. �,. <br /> ~:PHONE Fes•. INFr.lA S �: <br /> REVIEWED YES 'NO REVIEW DATE. ' <br /> EHD 44-02-0GG <br /> 1UE1200] <br />