Laserfiche WebLink
Aut-09-04 21:43 From-TTI TETRA TECH Fu IHC +9169520307 T-017 P.01/02 F-227 <br /> 1.e' `0ow FHP LOG NUMBER <br /> PATE RECEIVED SAN JOAQUIN COUNTY <br /> REMIXED ENVIRONMENTAL.HEALTH I)EPARTME44T <br /> 304 F Wi-ber Ave 3`d Floor Stockton,CA 9520 j4b <br /> AUG 10 2004(209)46$-3420 Fax:(209)464-0135 Web: www.co.szm-joaqui1 ca.us/ehd <br /> ENV1huiviNENT HEALTH PUBLIC RECORDS RELEASE APPLICA RON <br /> PE J <br /> APPUCANT*. VNL3t L- (-DIZW-Z-'-J BUSINESSIAGENCY. EF TZA l fC-" c;�m.L <br /> ADDRESS 1 1K 7 I NChFO Gott V G4 <br /> PHONE: C(1 o— E 53- 4 544 FACSIMn-E: 1 - <br /> TENTATIVE'APPOINTMENT DATE: 2'2 r ( 2-ory Time: <br /> �t (Please aline,10 tiv*imwe days from date of application suplm al) <br /> I-1 CHECK BOX TO WEP(TE REQUEST-593-011 FEE–REQUEST PRROC <br /> ESUDIN13B11AINOSSDAYS <br /> SIGNATURE OF APPLICANT DATE d <br /> DepamrAl use Only <br /> ADDRESS UNIT <br /> (1`7f , e,,,,, 222 E. "IB N-417, unit t <br /> 2. 1;4— o S- A 1 <br /> 3 S... .315 e q unit 2 <br /> 4 seen 3 t- <br /> 5. sue. 1r. _ c Unil3 <br /> Soy.1 s 2 S. ` T- c 5 <br /> �� c � Unit4 <br /> u' a suer 20 S'. �/N X41 L-Nel /I r j e. I <br /> �� O su.� a A/1 a D. c. dd ATB <br /> t 5 <br /> 03 E Oaf <br /> ce T L <br /> u u - <br /> ENVIRONMENTAL-HEALTH DEPARTMENT FILE <br /> UNDERGROUND TANK(USTI CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SO D WASTE FACILITY <br /> 4C OTHER CLEANUP SITE(NON-LOP) 1:1 FOOD FACILITY Q 50 D WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DY <br /> HAZARDOUS WASTE GENERATOR ❑ CRICKEN RANCH C) PK TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY ❑ MOTFLIHOTFL ❑ Pu PER 7RUCK/YARpICHEM TOILETS <br /> ❑ TATTOOIUOPY PIERgNG M POOLISPA ❑ b U59 APPLICATION SITES <br /> M MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> I. List up to ten addresses in the space above. Select the type(S)of files am the list above by checking <br /> the appropriate box(es)- At least one file type MUST be selected. Fax t 209 464-0138 or mail to the <br /> address indicated above. <br /> 2. FHP will notify the applicant if any EHP files exist. An appointment for eview will be confirmed <br /> approximately five business days put no later than ten(10)days after eipt of application. The files <br /> will be held fora maximum of five business days for review. Appointm me should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHP staff may not be immedia ely available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any fila not returned in the same condition as released will be reorgan' by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require $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 busines day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW PATE <br /> En049-0]OW _ <br /> 4eRWl <br />