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07 26/2004 13:04 FAX 209 9480( " 0002 <br /> $ DATC RECEIVED <br /> DD SAN JOAQUIN COUNTY <br /> E!) ErivWONMENTAL HEALTH DEPARTNtENT <br /> ' - = 304 E Weber Ave 3 Floo[Stockton,CA 95205 <br /> JUL 2 6 200(1209) 468-3420 Fax: (209)464-0138 Web:Yrww.co,san joaquilo.=us/chd ZO <br /> ENVIR014MENT HEALTHi�. <br /> P PUBLIC RECORDS REVEA•SE APPLICAMN <br /> APPLICANT: �-J� S' 6USUNESSlAGF1'ICY: <br /> ADDRESS: ti 'i. <br /> MONF_ FACSIMILE, ' d 6 :2, 1 <br /> TENTATIVE'APPo1NWEHT DATE: " --- ' _Time: <br /> it <br /> (Please alloy 10 busiAer-S days from date of application submittal) <br /> 1 <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE--REQUEST PROCESSED IN 3,BU5INESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> � F <br /> i Departs e l Use ONY <br /> FILE ADDRESS .1 UNrr <br /> saga Z r-j 9 L ❑ Unit 1 <br /> �. s 5. t ':i ,�l > unit 2 g_ U <br /> .S i � / <br /> f <br /> i� u it 3 <br /> 5_ skW �{ <br /> s sLm�t !i nit 4 <br /> 7 Snacl <br /> a. Snag <br /> 9. > a 0 unit s <br /> ENVIRONM ENTAI-HEALTH DEPARTMENT FILES '- <br /> 11 , <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT1 �WASTE FACILITY <br /> ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ¢F+OTHER CLF,MUP SITE(NON4-OP) EL DAIRY <br /> ($ UNDERGROUND TANK(MONrTOFt1HGfREIAOYAL) C7 CHIGCiSENNEN RAHCIi 15 PKG TREATMENT PLANT <br /> Q ktAZARPOt1S WAS1 E GENERATOR ❑ MOTEL A40TF-L :, ❑ PUMPER-rRUCKIYARD1ClilrM TOfLETS [ <br /> r3 TIERED PeMrmn FACILITY E3 p00LISPA i{ 'al LAND USE APPLICA-00N SMS I <br /> ❑ TATTOOMODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> E3 MEDICAL WASTE FACILrrY <br /> } <br /> List up to ten addresses in the spate above. Select the types)or files from the list above by checking <br /> the appropriate box(es). At least one file hype MUST be selected. Fax to 209 464-0138 or maII tO the <br /> address indicated above. c <br /> ointment for review will be onfirmed <br /> x EHD will notify the appucaInt If any EHD files eXist. An app <br /> approximately five business days but no later than ten(10)daysxima Appointments should be scheduS der receipt cf:appIIr_-aUon, The f des <br /> will be held for a maximum of five business days for review. APP <br /> accordingly. <br /> 3. A file that is at;tively being worked on by E <br /> application may be submitted when the file Is availHD staff blay not be immediately availablQ for review. Anew <br /> l be reorganized by <br /> he expense <br /> 4, Any file not returnedinure file reviews by the same applicar�tilt may require a$93.00 dep0 I Prior to review <br /> of the applicant. 1= <br /> g 'TENTATl1/1~appointment dates must be confirmed with EHD staff. <br /> s. Applications recelved after 3.00 pm will be processed th�next business day. <br /> `TOME <br /> MED•YPotNfWf_NT OAYE <br /> DATPHO <br /> E GQNFIRIV(EU } <br /> REV1>-WED YES NO REVIFVY DATE ' - <br /> 9901342409 <br /> W I� <br />