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TDA'iERECEwED • <br /> -,I _ SANJOAQUINCOUNTY • rauwl,rul.i:u: <br /> i. ' 11 <br /> j'` r'i_.I[' EN,-IRONMENTALHEALTI3DIPART <br /> i--—' HENT <br /> 304 E Weber Ave 3'd Floor Stockton, CA 95205 / <br /> NOV 1 4 2003 (209) 468-3420 Fax-, (209) 464-0138 Web; www-G0,San•j0agU1n.Ca.11k1d <br /> ENViRUI1Ni fvT HEALTH <br /> ]E _ PUBLIC RECORDS RELEASE, APPLICATION ✓✓✓ «�///vvv <br /> ^L. <br /> APPLICANT: 0 _ Urv1, BUSINESSIAGENCY: 0 <br /> ADDRESS; �() �� � + <br /> c <br /> PHONE: '�� FACSIMILE: + <br /> TENTATIVE'APPOINTMENT DATE: <br /> _TimD: <br /> (Plcasa allow 10 buslness days from date Of application submittal) 11E!1� <br /> w <br /> CHECK BOX TO EXPEDITE REQUEST•$93.00 FEE-REQUES PROCESSED IN J BUSINESS DAYS LC03 <br /> SIGNATURE OF APPLICANT <br /> ---_� DATE Z27�1 <br /> USTDowrtntcnt Use Only <br /> FILE ADDRESS <br /> 1. swevi iz UNIT <br /> 1 SVnel � <br /> Unit 1 <br /> J. Strael t_ LI <br /> VStreet r 3.`amu <br /> Gu /( 1` <br /> 3. Sire � � 1 r <br /> 9, 9Vao1 1 __ <br /> Gi Unit <br /> • �. suets �' /• - 7 C.[/I <br /> i <br /> i Cil <br /> e. vI9/., <br /> /✓ AU <br /> 4 <br /> 8. Slrcci �'9(.�Ll .J 1/L�liS <br /> lo, Sven _ — '� _ CRY - ,1•� �j Unit 5 <br /> � ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SrrE(LOP) USING ABATEMENT 13SOLID WASTE FACILITY C - <br /> - �_ THER CLEANUP SITE(NON-LOP) ta'�FOOD FACILITY <br /> 1'2rERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ SOLID WASTE VEHICLE <br /> IAZARDOUs WAs'rE GENERATOR 11 ❑ DAIRY <br /> CHICKEN RANCH ❑ PK TREATMENT PLANT <br /> [¢7� <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ MPERTRUCIGYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING O pOOLISPq - <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) LAND USE APPLICATION SITES <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 (2091464-0138 or mail to the <br /> address indicated above. <br /> 2, THD 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 be immediately available for reviow. 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 $93.00 deposit prior to review. <br /> 5• `TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day, <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIAL$ <br /> REVIEWED - YES NO REVIEW DATE <br /> HD 08-03•eec <br /> nrezooJ <br />