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RUG. 2/. 2UU4 4:4UNM I COR EAKIH IKH N0. 6355 P. 1 <br /> DATE RECEIVED ' <br /> SAN JOAQUIN COSY EHD LOG NUMBER <br /> ENVIROYMENTAL HEALTH bEPARTMINT <br /> 304E Weber Ave 3`d FIoor Stockton, CA 95205 <br /> AUG 2 7 ZVO)468-3420 Fax: (209)464-0I38 Web: www-CO-San-joaquin,ca.us/ehid <br /> E HENT HEALTH PUBLIC RECORDS RELE <br /> MIT� ASE APPLICATTON <br /> CANT' <br /> �j (�,� <br /> I`""' {�S 13U5INESS/AGENCY: o 6 /PGi[/Gp1p j�5 LKC. <br /> ADDRESS:-/89a S T ^' <br /> PHONE: d — Z —ov'6 FACSIMILE: 20 zs �- <br /> TENTATIVE APPOINTMENT DATE: /O 5;2 a Gr 2,004 Time. g Q AM <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX To EXPEDITE REQUEST-$93.00 FEE_RE EST PR ESSED IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATEZ 0 <br /> Departure Use Only <br /> FILE ADDRESS UNIT <br /> +. street a K al S�a<_ic <br /> z skeet d$ ❑ Unit 1 <br /> ✓ 3. Slew 7a Ci( u / (_0 <br /> � . �` n it 2 <br /> 3traet '� G (-7,jz <br /> ��� S. s eel 1 (e Ct �7 }/I 8�5 Lfistreet Unit 3 <br /> �. S'GaL ,So 2_ d. at 9C5 SJ41 <br /> a- street 1 19U0 4 <br /> � Ci. <br /> 0, s rew 13 cily 0440. <br /> 10. street I {� O City Unit 5 <br /> 1,L <br /> ENVIRONMENTAL HEALTH DEPARTMENT 1711_€�P _9 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOD WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> 1%UNDERGROUND TANK(MONrTORINGWMOVAL) ❑ DOG KENNEL DAIRY <br /> W HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH A PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDlCHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑_POOUSPA ❑ LAND USE APPLICATION SITES— - - <br /> 0 MEDICAL WASTE FACIUTY C 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 /> �. END 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, 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 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 /> 61 Applications received after 3:00 pm will be processed the next business day. <br /> bINTMEN <br /> at>ri >=ililil }; <br /> lea, <br /> HO 4&02.006 4•. `'•, .," ' <br /> V#/2M 131 C1 1 lGLiyJvl R'5 7 15 cr,. D A. Cd5 e <br />