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SEP-'03--2003 WED 03:40 PM SECOP-PORTLAND FAX NO. 50360P-7074 P. 02 <br /> SATE lVEHD LOG'NUMSER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL REALTia DEPARTMENT <br /> SEP 0 3 2003 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.uslehd <br /> FNVIRCIN1001' HEAL1 H <br /> PERM[TiSERVIUS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Amho �' _`��� 6USINESSIAGENCY: �CL/1� IV4 -L1_ fG�_rE�'. li�1C• <br /> ADDRESS:4-T M� �� Q _qTO( Z <br /> PHONE. 503 6 7"1—Z'0 31FACSIMILE: °I <br /> TENTATIVE*APPOINTMENT DATE: <br /> (Plaaae allow 10 uslness days from date of application submittal) <br /> ' I <br /> CHECK BOX TO EXPEDITE RE U 3.0 UE PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT RATE <br /> Departrmnt Use Only <br /> FILE ADDRESS UNIT co <br /> S.NJ 25 1 1)ar(H VAtKWCILAci a Irc %6 <br /> unit S <br /> 2. SW"t w s Arper i c/C L4S <br /> O d aly C3 Unit 2 Q <br /> e. Stm.t city <br /> nit 3 <br /> OOOW <br /> Unit 4 <br /> ❑ <br /> e. sewer <br /> s. Street G Unit 5 <br /> ' 10. Sesai Ci <br /> 1 <br /> ENVIRONMENTAL-HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 13 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ;eT FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ]l9 TIERED PERMITTED FACILITY C1 MOTELIHOTEL 0 PUMPER TRUCKlYARDICHEM TOILETS <br /> 0 TATTOO/BODY PIERCING 0 POOLISPA LAND USE APPLLII��ATi014 S"'ES <br /> CI MEDICALWASTEFACIL1TY �fl OTHER(PLEASE SPECIFY)�IS�S alwve rv,irdS'tbru hk <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(g,09)464-0138 or mail-to the <br /> address 1130igated above. <br /> 2. E1413 will notify the applicant if any EHD tiles exist. An appointment for review will be confirmed <br /> approximately five business days but no later than tdn(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 /> r 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. Anew <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 review. <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 /> CONFIRMED APPOINTMENT DATE TIME ' <br /> 00E.CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> IN2003 <br /> "' I <br />