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NDOR EARTH TECH <br /> 209 532 0773 P.01i0 <br /> - SAN JOAQM COUNT-y EHD LOG NUMf <br /> ENV)R01V1l�Ely7'AL HEALTH DEPARTMENT <br /> 0 C% j , 2004 304 E Weber Ave 3 <br /> (209)468-3420 Fax: (209) 464-OI38 WeFloor Stockton CA.95205 wvvw.cD,san_joaqurLMUS/eh167Z <br /> P_frII , <br /> PUBLIC RECORDS .RELEASE APPLICAITON <br /> APPLICANT: <br /> p : <br /> ADDRESS: 9USINESSIAGENCY <br /> "f � Nn p �j �-�q7•.�.���r5 <br /> PHONEF. ��:rj' /`� -/�• h T_ FQ_' <br /> TENTATIVE"APPO) _ Cl <br /> N hNENT DATE: o7g (3(In a <br /> Time: ; <br /> (Please allow TD business days hom dm. f <br /> aPPnmtlnn submittal) <br /> CHECK 60X 70 EXPEDITE REQUEST-.$93,00 FEE_REQUEST PROCESSED IN 3 BUSINE'9.q DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> K1LE'AODRESs D@Petiment Use Ordy <br /> Z �ATH2o uNrr <br /> a" st" s INS <br /> 0 Unit i <br /> o. seen na /�'4' 'Unit 2 V' <br /> 6. SaM 6 L O / -- �' <br /> r, so.e p _ )� $ Unit 3 <br /> e. Skeet � a /------ - - <br /> 9, ao Unit <br /> +a. Sven _'-_-_-- <br /> cnv ❑ Unit 5 <br /> �( ENVIRONMENTAL HEALTH DEPARTMENT FILES Vhf} <br /> CL UNDERGROUND TANK(UST)CLEANUP srrE(LOP) ❑ NOUStNG AeATEMENT <br /> OTHER C:"EANUP 3173;(NON-LOP) ❑ FOOD FACILITY ,/SOLID wA'TE ILITY <br /> Ay UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DPG KENNFL 7° SOLro WASTE VEHICLE <br /> )r�' HAZARDOUS WASTE GENERATOR ❑ cHicKEN RANCH r DAIRY <br /> TIEREC PERMITTED FACILITY Q MOTELIHOTEL ❑ pKG TREATMENT PLANT <br /> O <br /> TATTOMODY PIERCING LJ POOL/SPA 0 PUMPER TRUCWI'ARD=EMTOILEM <br /> MFOICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) J;VLAND USE APPLICATION SITES <br /> 1. List up to tan addresses In the spate above. Select the type($) of files from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected, Fax to L209) 464.0138 or mail to the <br /> address indicated above. <br /> 2. HHD 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 file <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 net <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 expens <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to reviel <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 /> F <br /> RMED APPOINTMENT DATE <br /> TIME <br /> ONFIRMED PHONE FAX <br /> ED INiT fAL5 <br /> YES NO REVIEW DATE <br /> TOTAL P.O <br />