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FUG. 21. 2UU4 4:4UPM VUUIi tAKIH ItCH NO. 6M P. 1 <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> rNVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> AUG N 7 ZOPW)468-3420 Fax; (209) 464-0138 Web: www.co.san.joaquin.ca.us/ehd <br /> E I Lwl HEALTH PUgLTC RECORDS RELEASE APPLICATIONI <br /> ICANT G T <br /> ICS• 4�rf L1.¢5 BUSINE53lgGENCY: Dr �+.f'IGe ��/Lp/G iE5 1 VI C. <br /> ADDRESS: 18B T'yaln 4.Fz, Civ Sty 1f ri7(Dcfc4-o iA '1520(. <br /> PHONE: d — 2-3 -Ove FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: /O SQ a er 200 rme: S_ '�M <br /> �y (Phase allow 10 business days from data of application aubmlttal) <br /> u CHECK BOX TO EXPEDITE REQUEST-$a3.00 FEE—RE ZEST PR CESSED INS BUSINESS DAYS <br /> SIGNATURE OF gppLICANIT _ DATEZPU,,Only artur <br /> FILEADDRESS L / UNIT <br /> 1• SIM91 -t Gf SfaGle <br /> b2 iA <br /> 2. s "d S =s <� Qty HA E ❑ Unit 1 <br /> e. s <br /> Q o <br /> 24 `;,-',�r i 7. at U -I Z � '; iaG_ o - <br /> ,. sreg -"f ❑ Unit <br /> s. si ! b WSJ i r; Ll at 5f 14A <br /> rt,et o a a ? X Unit 3 <br /> ]. 6 <br /> fl 6oae� 1 19 p a ZUnit4 <br /> 9. 505M <br /> GI O <br /> v❑ /Unit 5r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES I� �f�1 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) Cl FOOD FACILITY SOLID WASTE VEHICLE <br /> IXUNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL DAIRY <br /> HAmkuouB WASTE GENERATOR O CHICKEN RANCH M PKG TREATMENT PLANT <br /> ?9-TIERED PERMITTED FACILITY Cl MOTELIHOTEL 11 PUMPER TRUOK/YARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING 13 PDOUSPA O LAND USE APPLICATION SITES -- <br /> O 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(208)464-0138 or mall to the <br /> E <br /> ddress 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 bet 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 review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with END staff. <br /> 61 Applications received after 3:00 pm will be processed the next business day. <br /> k�]V( P CNTME� <br /> ''„�<?• Eb Via: b <br /> T <br /> Ulf E'; <br /> 7 <br /> :1ti . <br /> N1. <br /> 4fi fASC <br /> 3r`t3NFl <br /> Iy. .. RM�D, <br /> ON ,L,,,1,.` <br /> thllltf9p ij„ 'I .' :ryFS <br /> N <br /> �f�uV:�sarr <br /> $W2003 <br />