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3/02/2004 12:09 FAX 209 9480621 iaOO2/002 <br /> N DAVE RECEIVED , _ cri w <br /> SAN JoAQu1N CoYnv7['x <br /> I1���ISU V IS <br /> ENVIRONMENTAL FTEALTHDEPARTMENT <br /> 304 E Weber Ave 3d Floor Stockton, CA 95205 <br /> MAR 0 2 2004009)468-3420 Fax: (209) 464-0138 Web:www.cosan-jQaquiu.ca-us/ehd <br /> ENVIRONMENT HEA (H <br /> Prnnrn1T1cr=lzNrlrF PUBLIC RECORDS RELEASE APPLICATION <br /> APPt1cANT: I Jt..� SiP?1-� S BUSINESSIAGENCY: <br /> ADDRESS: <br /> PHONE: �l ut�'�'��-lS FACSIMIIF •aI{76 b 6•1-t <br /> TENTATIVF*APPOINTMENT DATE: 3-I1 L' o L( Time: I2UD <br /> I (Please allow 10 busirw_ss days from date of application submittal) <br /> ❑ e.. <br /> CHECK BOx TO EAPEOITE REQUEST-$93.00 FEE..REQUEST PR ED IN]BUSINESS DAYS [ 4 <br /> SIGNATURE OF APPLICANT DATE D <br /> fDepartment Use OnN <br /> FILE ADDRESS UNIT <br /> • ,. s R D Si. LA0 ❑ Unit 1 <br /> • z. suer J\G� <br /> z. srcc, Iq 3 S . cur LjV I Unit 2 1 <br /> s. sea S t -4. Unit ,X49 <br /> . s. soca ; W E• W <br /> • t. s� M' Lo Ste. �. c Unit4 <br /> C"y %—pis 1 4 <br /> iIAP 12 2004 ❑ Unit 5 <br /> 1D. SrceCRY j <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES l <br /> P4 UNDERGROUt O TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT AM SOLID WASTE FACILITY <br /> 6C OTHER CLEANUP SITE(NON-LOP) ❑ F000 FACIL" ❑ SOUD WASTE VEHICLE <br /> is UNDERGROUND TANK(MONITORINGIREMOV/LL.) ❑ DOG KENNEL *U DAIRY <br /> ®'HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 417 PKG TREATMENT PLANT O <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 11PUMPER TROCKIYARDICHEM TOILETS <br /> 0 TATTOOIBOD? PIERCING ElPOOLISPA 9 LAND USE APPLICATION SITES <br /> C3MEDICAL WASTE FACIL (Pt_ <br /> rIY r] OTHER EASE 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 /> appSoximately five business days but no later than ten(f 0) 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 he submitted when the file is available. <br /> 4. Any Ile not returned In the same condition as released will be reorganized by EHD staff at the expense <br /> Of t�e applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review <br /> 51 '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 /> i <br /> C73NFI,f <br /> MED:APPo1NiMEN7't7PSE` - - TIME <br /> °DATF-CON) 112h�EU_ ^ PHONE = FAX <br /> REVIEWED YES NO REVIEW DATE. <br /> EW Taazaoa I, <br /> mwr <br /> f. <br />