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Jun 23 04 11 : 55a <br /> P. 1 <br /> 06/23/2004 10:50 4640,38 ENVIRONMENTAL HI H PAGE 01 <br /> p�T> RECEyWCP <br /> IA�C� SAN 30AQ•.IE`t COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUN 2 3 2004 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:www.co.san-joaqujn_caus/chd <br /> tlVViIH uNP;9ENT HEALTH <br /> FECORDS RELEASE API PLXCA/ fI'��0�/N 1972 <br /> APPLICANT: S C13- SUSINESSIAGENCY: � l o� �C_/1 f` C.( <br /> ADDRESS: <br /> 2-,,)q 1rI `T <br /> 3 <br /> PHONE: L <br /> TENTATIVE*APPOINTMENT DATE: L'.(i - (Z�1L 3 <br /> (Please allow 10 bu:IA@49 d ftatdatoefiP000&tIQ bmaul) <br /> r-+ CHECK BOX TO EXPEDITE REQUFS - 93.00 FEE- PROCE 19 3 Bu31Nt:SS DAYS J <br /> SIGNATURE OF APPLICANT �� <br /> DeparCnent Use Only <br /> FILE ADDRESS UNIT <br /> WZ 0. y G /G ❑ Unit 1 <br /> 2, Wed <br /> a. sues ❑ Unit 2 <br /> �Unit 3 <br /> s. svee� a <br /> 7. Stcity <br /> — <br /> e, sever <br /> s. s� <br /> a. 911M a <br /> ty <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> aq . <br /> y <br /> UP SITE OP ❑ HOUSING ABATEMENT O SOLID WA§TE FAk -� ��, ts, <br /> UNDERGROUND TANK(UST)CLEAN (LOP) o SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) D FOOD FACILITY <br /> XCUNDERGROUND TANK(MONITORING/REMOVAL) O DOG KENNEL R DAJRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH C] pKG TREATMENT PLANT <br /> ❑ TIERED PERMTTTED FACIUTY d IMOTEtiwTEL ❑ PUMPER TRUCK/YARWCHEIM TOJLETS <br /> ❑ TATTOOIBOOY PIERCING Q pOOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPEC]FYI — <br /> he <br /> m the r1st aboye by <br /> thea ptropriate box(s). )Attleashe toone filace e vtype MUST ve- Select tbe s selected, Fax to( checking209)64-0138 or mall to t e <br /> addross Indicated above. <br /> 2. EHD will notify the applicant H 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 flies <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 /> appUcation may be submitted when the file is avellable. <br /> 4, Any file not returned In the same conditions released will be reorganized by EHD staff it 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 /> 8, Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED-A P0I ' ENT DATE TIME ' - <br /> DATE CONFIRMED = _ •PHONE FAX ` :INnlALS. <br /> REVIEWED YES NO REVIEW DATE' <br /> EMo .02400 - <br /> �1ag003 <br /> r� T <br /> 1 <br />