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03/0 //22005 11::0\5�FA% 209 9480621 0 [�j002 <br /> �DAf 17I�E� L u V Frei ;J SAN COUNTY <br /> A 3 2005 ENviRoNN NTAL HFAz,TH DEPARTMENT <br /> 304 E Weber Ave 3 Floor Stockton, CA 95205 I <br /> EfdViROPi�icNl(R09�"{}68-3420 Fax: (209) 464-0138 Web: NwnY.co-sanjoaquiu.ca.us/ehd I <br /> PER MjIT/SERVICES <br /> J PUBLIC RECORDS RELEASE /APPLICATION <br /> APPLICANT: / guffA— JVat e, EUSINESSIAGLNCY: KI <br /> ADDRESS: <br /> PHONE: � ^ ISYS' ( _FACSIMILE: l7a�) _ q��•t562-f ' <br /> TENTATIVE.APPOINTMENT PATE- (�5I( ('j Tim, _ <br /> (Please allow 10 pusiness,days tram date of application submittal) ) 5 <br /> CHECK BOX TO EXPEDITE REQUEST-593.00 FEE—REQUEST PROCESSED IN 2 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /1/i ��� /� DATE <br /> i <br /> ' Department Use Only <br /> FILE ADDRESS UNIT <br /> G a <br /> } _ Unit 1 <br /> c <br /> GUnit Z <br /> VHS UsT ,. MANI Ekt a <br /> s. sem' G Unit 3 <br /> a Srecr G <br /> T, sued G f Unit 4 <br /> a. sum G <br /> y- y,tiy G s E] Unit 5 <br /> f0. Srmf G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) U HOUSING ABATEMENT BI.sQuo WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOPT ❑ FOOD FACILITY ❑ SOLIO WASTE VEHICLE <br /> V;- UNDERGROUND TANK(MONIIDRLNGlREMOVAL) ❑ DOG KENNEL �DAIRY <br /> ffi HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH �PKG TREATMENT PLANT <br /> ❑ 71EREO PERMITTED FACILITY ❑ MOTEVHOTEL ❑ PUMPER TRUCIOYARDICHEM TOILETS <br /> ❑ TATTOOMODY PIERCING Q POOLISPA M LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE.9PECIFYt . <br /> 1. List up to ten addresses in the space above. Select the types) of files from the list above by checkin <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the <br /> address,)ndicated above. <br /> 2_ EHD will notify the applicant if any EHD flies 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 ne% <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 reViet <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff, <br /> 6. Applications received after 3;00 pm will be processed the nextbusiness day. <br /> 'CON Jf;Ma APROINTMENT PATE.' „a jIM <br /> DQTE,GgNFIRMED;'. -- - ,:PHONE FAX <br /> REVIEWED YES NO REVIEW DATE <br /> ' EHo�ialaa6 <br /> u.nnm <br />