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Jun. 2. 2005 2:51 PM ONCED GEO 0 No. 0833 P. 1 <br /> DATE RECEIVED EHD LOG NUMBER <br /> ����r ��t1 n ��-�� SAN JoAQtmv COUNTY <br /> L� �J IJ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 ;^ <br /> JUS 0 2 Z@h)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/chd <br /> EWRONW,ENT HEWH p LTC RECORDS RELEASE,fAPPLICATION// o/rrL <br /> APPLICANT; I USINESSIAGENGY; I�.tOUQnced V'-i/�-r.wliwmp-A (- <br /> ADDRESS: $37 LSI1Gla) P6a d S7yc M�1a 9S/a/7)s`- <br /> PHONE: 909- I- 1106 FACSIMILE: VlC / —djy <br /> TENTATIVE*APPOINTMENT DATE: OS Tim: /0-11k, <br /> (Plea6e to �tp 60sin from ap 11 tl n submittal) <br /> CHECK BOX TO EXPEDITE RED ST- 9.1.00/NFERE U 7 PRO ES I BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> J.*.g FILEADDRE55 ((pp�� UNIT <br /> oql�1Ei ISr T <br /> fivaet Gyzt K 9 L• 9 Z — Ctty ❑ Unit 1 <br /> Z. 6t., <br /> 1 Swet [] Unit 2 <br /> Sae., ule Uul� IATA <br /> s. sae.t RJ "# th <br /> Unit 3 <br /> a sawn as 4 <br /> T. seem - VUI$ /Unit 4 <br /> D[d nrl� e ❑ unit s <br /> 10. 5o f G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NOWLOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL LT DAIRY <br /> HAZARDOUS WASTE GENERATOR Ll CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK(YARDIGHEM TOILETS <br /> ❑ TATTOOBODY PIERCING I7 POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFIC <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 /> approximately rive business days but no later than ten (10)days after receipt of application. The rites <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 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 /> C.ONF(RMED APPOINTMENT:DATE 1 'TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHG gr-0Z-0OB <br /> BIalZOW <br />