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07/05/2007 11:44 53067666 5 STRATUS NO CALIF PAGE 01/01 <br /> 05/11/2004 14:50 4640135 ENVIRONMENTAL HEA* PAGE 01 <br /> tnu LVU rvumocn <br /> DATE REOSIVED SAN JOAQTA N COUNTY <br /> E)YMO11IV1"kNTALHEALTH')Fr iTMENT n <br /> 304 E Weber Ave 3r4 Floor Stockton,CA 95205 V <br /> (209) 468-3420 Fax. (209) 464-OIIS Web:www.cosan-joaquin.ca u5/ <br /> `` II PUBLIC RECORAS RELEASE APPLICATION <br /> 5��� �j l BUSINESSIAGENOY: <br /> APPLICANT: Can, 4 �C �I P <br /> APPLICANT' <br /> � . <br /> HOME:?k) ]ID' 1 '7 rACSIMILF:. <br /> TENTATIVE APPOINTMENT DATE: <br /> JL, Time: <br /> (Please allow 70 business der frum date or appliwtlon subm(nal) <br /> ❑ CHECK BOX TO EXPEDITE REQUE$,t0 FEE-REQUEST PROCESSED IN 3 sUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT pepartment Use OnIV <br /> UNIT <br /> FILE ADDRESS <br /> 10 bJe k 4J Cl S ❑ Unit <br /> s6 5 <br /> ¢, an { [] Unit 2 <br /> a. seed <br /> p�)'lt bra ci �1 <br /> G \ <br /> +. ❑ Unit 3 <br /> G <br /> a ��� Unit4 <br /> a <br /> 7. Spee <br /> a <br /> a � � C ❑ Unit 5 <br /> m <br /> 10, <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> :3 HOUSING ARATEMENT O SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE t- <br /> p pt'HQR CLEANUP SITE(NON-I-OP) ❑ DOG KENNEL ❑ DAIRY <br /> UNDERCROU ND TANK(MONITORINGIREMOVAL) C CHICKEN RANCH rl PKG TREATMENT PLANT lCHEM TOILETS <br /> ❑ HAZARDOUS WASTE GENERATOR 173MOTELMOTEL ❑ PUMPBRTRUcKIYARD <br /> p TIEREO PERMrrrED FACILITY ❑ POouSPA ❑ LAND USE APPLICATION SITES <br /> C1 TATTOOJBODY PIERCING n OTHER(PLEASE SPECIFY) <br /> ❑ MEDicAL WASTE FACILITY checking <br /> 1• List up to ten addresses in the space above. Select the type(s)of files from the list a 38o m 9 <br /> the appropriate box(es). At least one file type MIDST be selected. F o 209 464-0138 or mail to the <br /> address indicdayted abpove. ointment for revlew will be confirmed <br /> y. EKD will not' thea applicant ii any EHD files exist to app ter receipt <br /> should be scheduled <br /> approximately five business days but no later than ten (10)days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments <br /> accordingly. of be immediately available for review. A new <br /> 3• A file that is actively being worked on by EHD staff may n <br /> application may be submitted when the file is available. <br /> 4, Amy file not returned in the same canditlon as released Will licantmay req be area$nid b3 EHD staff at the P.Xpense <br /> 00 deposit prior to review. <br /> of the applicant, Future file reviews by the same app <br /> G. `TENTATIVE appointment dates must be confirmewith EHO Staff. <br /> Hent b sines day. <br /> 6tDATE <br /> Applications received after 3:00 pm will be processed <br /> TIME <br /> CONFIRMED APPOINTMENT DAtE INrf1ALS CONFIRMED PHONE . PAXIEWED <br /> YES NO REVIEW DATE <br /> eno, 6. <br /> e,rmos <br />