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DATE RECEIVED`I ,EHD COG NUMBER <br />fl`�n2,rr" SAN JOAQUIN COUNTY <br />Ir��L I ENVIRONMENTAL HEALTH DEPARTMENT !! <br />zoo, 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br />OCi 1 1 (2 09) 468-3420 Fax: (209) 464-0138 Web: vAW.co.san-joaquin.ca,us/chd <br />FlvAIv��hl-1C��1 �V� �-�j <br />M c.PUBLIC RECORDS RELEASE. vAPPr�LICATIeO� N <br />APPLICANT. Alo-" PtkC U BUSINESS/AGENCY: -Az,\ D. Pfv,a s'n^ c. <br />ADDRESS: I�Z 1v�t%NS�h�a-Q USN. -1 Lod...' <br />PHONE: 3� —�� FACSIMILE: (9 <br />i <br />_ TENTATIVE` APPOINTMENT DATE: Time: <br />- (Please allow 10 business days from date of application submittal) <br />5� CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE — REQUEST PROCESSED IN 3 BUSINESS DAYS <br />/SIGNATURE OF APPLICANT DATE <br />/D/II (Dy' <br />Department Use Only <br />FILE ADDRESS <br />❑ <br />7. <br />-1 <br />Street/ 0-4 N. S: IVk" ` ` S-1 .. <br />Ci <br />u4cu' <br />K <br />streetmt_341 , S. A\r dv* <br />C..S'�e <br />Gki6v�• Z <br />l51. <br />sued 2(o Sl S. Rl. n -F W <br />a <br />Skac�t�� :47 t <br />4. <br />street 11 �l C, . Yt\ a.i ✓\ S'l . - <br />- G <br />s'1-UY.I�'1"tih <br />S. <br />Street S 1 S�j (r. F1'1 n -c V` ,S� , <br />'q G <br />S'tLL✓0 <br />6. <br />street 3--440 [, �N9G. <br />'�y . . <br />-e �)I fja <br />,[,�i'l�"- <br />S, trvN Alf <br />T. <br />street 3 82 E. C—�K v <br />Ave UP` <br />S �1�-'Yam. Ak <br />a. <br />sv«t 3 r6U f , C3vt. iz <br />(1v ZlU Fa <br />Sfiv c lGktr — IRZ <br />9. <br />Street E4-131 E E . m LU SA ./], <br />F G <br />S+V CIG6t'� <br />10. <br />tY <br />street K� '511 N • _ T n.Y"1 Ul'� 1" 1 "� . OL, <br />tet., <br />gib11- {'in.— -) �v <br />/D/II (Dy' <br />Department Use Only <br />UNIT <br />❑ <br />Unit 1 <br />❑ <br />Unit 2 <br />Unit 3 <br />OillMbmft <br />Unit 4 <br />Nth nit 5 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES ! <br />. UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />❑ DOG KENNEL ❑ DAIRY <br />UNDERGROUND TANK GENERATOR <br />❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />j� <br />HAZARDOUS PE WASTE GENERATOR ij <br />TIERED PERMITTED FACILITY ❑ MOTELMOTEL 13 PUMPER TRUCK/YARD/CHEM TOILETS <br />TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES .I <br />❑ MEDICAL WASTE FACILITY ❑ 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 />2. EHD 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 l <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 r 'e <br />5. 'TENTATIVE appointment dates must be confirmed with EHD staff. Alift <br />6. Applications received after 3;00 pm will be processed the next business day. ! <br />WmFIRMED.APPOINTMENTDATE <br />, TIME f <br />DA7E CONFIRMED 'PHONE FAX INITIALS''. <br />REVIEWED _ YES NO REVIEW DATE <br />EHD 4"2L06 <br />&1=000 <br />