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"71-22/2002 10:22 FAX 209 948 06?'- KLEINFELDER _ { 01002/002 <br /> e+w L( Hu <br /> oa-rE net�veoIl93 D <br /> o SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> i j <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)4683420 �n <br /> PUBLIC RECORDS RELI=ASE APPLICATION R Ov�D <br /> f �pye-a- RUSINESSIAGENCY /C�e na e��e r L 2 2002 <br /> APPLICANT T F{EALZH <br /> c; zf <br /> n!/�$� M le- <br /> ADDRESS t'`� ���� i ENVIRO RVICES <br /> FACSIMILE �y�^ <br /> /aq/O-) IIyyTaIME <br /> TENTATIVE'APPOINTMENT DAT , a SPP lion subnitlat) <br /> (Pleasep iA T tv 10 hus,ne days I <br /> IJ CHECK BOX TO EXPEDITE REQUEST FEE-REQUEST PR SSED IN 3 SLNESS DAYS <br /> - s DATE <br /> SIGNATURE OF APPLICANT <br /> U ONLY <br /> FILE ADDRESS TFLIS SIDE EHD STAFF c <br /> PROGRAM ELEMENTS <br /> V qwU ;Zo i✓ Co.(: erne. a- <br /> CA <br /> a IS C�.f;forn:e c�1n� j <br /> U kockJvn Yy�l ce.., ene•I-er L.o.r� j <br /> !ti <br /> ENVIRONMENTAL HEALTH DIVISION FILES L <br /> ❑ HOUSING ABATEMENT .SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ElFOOD FACILITY sOLID WASTE VE)1 <br /> ,Z- 1CLE <br /> OTHER CLEANUP SITE DOG KENNEL ❑ DAIRY i <br /> UNDERGROUND TANK(MONITORING/REMOVAL) E3PKG TREATMENT PLANT <br /> ❑ CHICKEN RANCH ❑ PUMPERTRUCK&ARDICHEM TOILETS <br /> �V 'RA7ARDOU3 WASTE GENERATOR ❑ MOTFLiHOTEL <br /> TIERED PERMITTED FACILITY ❑-POOl15PA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PEIRCING C] PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> .e MEDICAL WAVE FACILITY <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the hst�a3 o by checking <br /> the appropriate bOX(eS). At least one file type MU5T be selected. Fax to (20 <br /> ql 464-013 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 a confirmed <br /> approximately five business days but no later than ten (ie days ointments shoulecelpt of p�be schad lu®aflles <br /> will be held for a maximum of five business days for review. App <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately availabl®for review- Anew <br /> application may be submitted when the file is available. at the expense <br /> HDj 4 of theAny le not returned in the applicant. Future files reviews by the same applicant maame condition as released will 130 require a$87.00 ddstaff <br /> sit prior to ev ew• <br /> 5• 'TENTATIVE appointment dates must be confirmed with EHD staff. j <br /> 6. Applications received after 3:00 pm will be processed the next business day_ <br /> s <br /> CONFIRMED TIME <br /> APPOINTMENT DATE <br /> DATE CONFIRMED PHONE FAX MITI" <br /> REVIEWED YES NO REVIEW DATE <br />