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11/07/2003 16:12 9168610430 <br />SECOR <br />PAGE 01/0 <br />DATE RECEIVED EHU LUL: NUMbMK <br />SAN JOAQUIN COUNTY <br />w <br />ENVIRONMENTAL HEALTH DEPARTMENT Weber Ave 3 Floor Stockton, CA 95205 <br />304 /^//J <br />.E <br />(208)' 4 8 34�L0 Fax: (209) 464-0138 Web: www.cosan-joaquin.ca us/ehd I <br />NOV 0 7 2003 PUBLIC RECORDS RELEASE APPLICA'T'ION <br />C NVIJiUNl�l-V? "�i BUSttjS3/AGENCY:,_ S£�o(Z +N'Ez�A zj A <br />APPI IGGNT"... <br />ADDRESS:__ '7., ro .,E�ev s orf loo >=�Nc•'o ami C',a Q�r'7r- <br />PHONE: 91(o) $col Z s FACSIMILE:C2¢y\ S!^(`dYSQ <br />TENTATIVE" APPOINTMENT DATE: U1,[8 - 9,2 /,n,; Time: Io:m_ A <br />(Please allow 10 business days from date of applIntlon submittal) -�?S <br />Q CHECK BOX TO EXPEDITE REQUEST. $93.00 FE -REQ ST PROCESSED IN 3 BUSINESS DAYS -- <br />SIGNATURE OF APPLICANT DATE 11/7�c-S <br />Department Use OntY 0 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />W OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />)RI" UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY qw**o <br />Z HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKfYARD/CHEM TOILETS <br />Cl TATTOOIBODY PIERCING ❑ POOLISPA O LAND USE APPLICATION SrTES <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 ane file type MUST be selected. Fax to (2091464-0138 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 ney <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 reviev <br />5. "TENTATIVE appointment dates must be confirmed with END staff. <br />6. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE _ <br />DATE CONFIRMED <br />REVIEWED YES NO <br />TIME <br />PHONE FAX <br />n.. .f- . K(K Gnpas,( <br />REVIEW DATE <br />INITIALS <br />