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DEC. 2. 2003 2: 54PM CO, OR EARTH TECH N0. 1619--P. 1 <br /> D�.._..---•-- O _ <br /> SAN JOAQUIN COUNTY • EHD LOG NUMBS: <br /> EN moNvI ENTAL HEALTH DEPARTMy, <br /> 304 E Weber Ave 3" Floor Stockton, CA 95205 ' f'', ' `J ` � ' - <br /> —1-1209)468-3420 Fax: (209)464-0138 Web: W-wW-co-Sa-Q-joaquin,ca.us/ehd <br /> PL BLIC RECORDS RELEASE APPLICATION 03 DEC —2 Ppb 3: 42 <br /> APPLICANT: LZ7� BUSINESS/AGENCY: <br /> ADDRESS: b�6 Vl/ I C(.�./ ST- <br /> loc KTa <br /> PHON ` `-L�i(�-- d� FACSIMILE: 341 S7 3 <br /> TENTATIVE'APPOINTMENT GATE: <br /> (Please allow 10 business days from date of application submittal) <br /> `— CHECK BOX TO EXPEDITE REQUEST-S93.00 FEE–REQUEST PROCESSED IN 3 BUSINESS YS <br /> SIGNATURE OF APPLICANT <br /> rte. <br /> DATE . <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> f t, su�w 0 S <br /> Stre <br /> C <br /> "` <br /> a ❑ Unit 1 <br /> v 3- Street � (1 g Z, <br /> / <br /> D 4. SVeel / <br /> a s. s;�� 0J4 <br /> 6, Street 11 V G _ Unl <br /> 7 <br /> o. sv f s ✓ nit 4 <br /> G <br /> Qli <br /> 10 s Mc ❑ Unit 5 <br /> c r <br /> 0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C1 HOUSING AUATEMENT <br /> OTHER CLEANUP SITE(NON-LOP) —. CI FOOL)FACILITY SOLID WASTE FACILITY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) Cl DOG KENNEL LI SOHO WASTE VEHICLE <br /> HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH ❑ DAIRY <br /> TIERED PERMITTED FACILITY ❑ M PKG TREATMENT PLANT <br /> TATTOO/BODY PIERCING OL/SPAT> ;L ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> OTHER(PLEASE SPECIFY) <br /> MEDICAL WASTE FACILITY ❑ ❑ LAND USE APPLICATION SITES <br /> ❑ OTHER <br /> 1• List up to ten addresses In the space above. Select the type(s)of files from the list aboye 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 <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 /> a. 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 /> 61 Applications received after 3:00 pm will be processed the next business day, <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE - FAQ( <br /> INITIALS <br /> REVIEWED YES NO R1wVIEW I)AT,SE- <br /> ENO Q-02-006 <br /> �> a� ol t.c./-1, { bvr <br />