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FROM : Ground Zero Analysis • PHONE NO. : 209 638 9993 ` Nov. 29 2005 10:19AM P2 <br /> EHD LOG NUMBER <br /> DATE MEWED <br /> SAN JOAQUIN COUNTY <br /> �j � II�VI L�D ENVIRONMENTAL HEALTHDEPAItT5 NT 304 E Weber Ave 3d Floor Stockton,CA 95205 103 <br /> NOV 2 !005 (209)468-3420 Fax:(209)464-0138 Web: www.co.san joaqum_ca.us/ehd <br /> ENVIRONMENT HEACI l PUBLIC RECORDS RELEASE APPLICATION <br /> PERMI <br /> APPLICANT: SUSINESSIAGENCY: <br /> G q <br /> ADDRESS/: I <br /> PHONE:la'! ) �u-�"6 FACSIMILE: <br /> 11� �A 't 1�I St1 <br /> TENTATIVE'APPOINTMENT DATF I O a yy-KY/ Time: U <br /> (Please allow 10 buslnesa days from date of 11131311atlon submittal) <br /> © CHECK 8OX TO EXPEDITE REQUEST-$13.p00 FEE n-R(E�QUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT S;k4 A DATE 9 <br /> —c'' Oepartrrrerrt Use OnN <br /> FILEADDRESS 3h UNIT <br /> s p rn �5 da ❑ Unit 1 <br /> 2 aYeet <br /> a. S1reN Q ❑ UnR2 <br /> d. Sbeet G <br /> £ s Knit 3 <br /> a. eaeer <br /> 7. ausac <br /> Unit 4 <br /> a saeec ` <br /> s s etc. C] Unit 5 <br /> m.'. sveet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tE"�IINDERGROUND TANK(UST)CLEANUP SITE(LOP) In HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> 6C pTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY CI SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK(MONITORIN(WREMOVAL) 0 DOG KENNEL O DAIRY <br /> 0 HAZARDOUS,WASTE GENERATOR O CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCK(YARDICHEM TOILETS <br /> 0 TATTOOI60DY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> CI MEDMALWASTE 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 ff any EHD files exist. An appointment for review velli 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 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 appiicaa 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 recelved atter 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS _ <br /> REVIEWED YES NO REVIEW DATE <br /> EXUd84!-0U6 <br /> XOf20W <br />