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�i 'r a -•., a-1.. t n x ,c ,rte 3 .� +. . <br /> fY �n � s, .' �.�ry yam,+-�*s °t�se:§'+ �., � '' i r,�,•.�;Wk�n.k�u'��^�� '�'�^.v..�x,�-�* �'"�' <br /> EN 11EiONt11L'1\1 L'�ii S,iY iJL'i i <br /> P 2qr? <br /> 9 ZQQ 304 E Weber Ave 3 I r Stockton,CA 96205Am U <br /> 209)468-3420 Fax:(204)464-0138Web: .co.san joaqum.ca.us/chd <br /> ENVIRC Ni t'vi HEALf H <br /> PES N11,1 vERVf G S PUBLIC RECORDS ASE APPLICATION <br /> APPLICANT: ni wear' :ase BUSINESS/AGENCY: +�*� <br /> ADDRESS,. 3'�'L, Pe.lae,e- �,,,., �i.,..d., Sw.' ea/f C��ro.....sK!-d G14 9 681JO <br /> PHONE: Q lie— 1&B -gy 34 FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: 1°•' ®Q.{ Tim: <br /> (Pleas®allow 10 business days from date of app9caftn submHtaq <br /> ❑ CHECK BOX TO EXPEDITE REQUEST.$93.00 FEE—RMUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Depadmeet Use Ordy <br /> FILE ADDRESS UNIT <br /> d ,. ri 5-;'C.> t: . CW VACA-*e- e-A °l52-5,5 ❑ Unit 1 <br /> �4/e4 a. Oct K-d ❑ Unit 2 �� <br /> s Unit 3 <br /> *Y*- <br /> 6. 8peet <br /> r. sem► CW Unk 4 <br /> IL sbek <br /> ,o. saeec <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IS.UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT (R SOLID WASTE FACILITY <br /> !a OTHER CLEANUP SITE(MON44M 0 FOOD FACLITY 0 SOUR WASTE VEHICLE <br /> IR UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 17 DAIRY <br /> 121 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 13 PKG TREATMENT PLANT <br /> It TIERED PERMITTED FACILITY 0 M 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> © TATTOOIBODY PIERCING 0 POOLJSPA 0 LAND USE APPUCATKNN SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER E SPEdFY) <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 fine type MUST be selected. Fax to(209)464-0138 or mall to the <br /> addmss indicated above. <br /> Z. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no Wer 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 EH may not be Immediately available for review. A near <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 /> 6. Applications received after 3A0 pm will be processed the next business day. <br /> ,,,.. ..- ••...,-.,-......-.tsrf:,.c,t•:.,..:-•trv.... :....,••. ..,. ...•:.:` .^y: ::>.r t,•: :':�''t:-e:'''�Tr{^•r:'}:.C' x':51.?+}f'k` <br /> MIX <br /> FEt _ - <br /> q-5D-0(4, ('e-r-t VM ('1/114ss %57SVa cfL9, 145� ?AVam�' <br /> q oq: Ptaad jA U/7; t. �'®1 ?S l l Z fy,. TOTAL P.01 <br />