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SECOR - PAGE 01/0 <br /> 11/07/2003 16:12 916661043 EHULU1i NUMtlCH <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL DEPARTMENT (—/ <br /> /, I' I_ 304 E Weber Ave 3d Floor Stockton CA 95205 <br /> Iril it 1!,��209y`458� �Ld�0 Fax: (209) 464-0138 Web:www.co.san-joaquin.ca.uslehd <br /> NOV 0 7 2003 PUBLIC FXj CORDS RELEASE APPLICATION <br /> APPLICAtl�tllf'iUN(���� <br /> �F- <br /> ADDRESS: " 0 ti <br /> b <br /> SIMILE: <br /> PHONE: Siff 8l01 <br /> TENTATIVE"APPOINTMENT DATE: I�:,�7s,-�� Time: /o'm <br /> (Please allow 1 a business days from date of applicatlon Submittal) <br /> Q CHECK BOX TO EXPEDITE REQUEST-393.00 FE —REO' ST PROCESSED IN 3 BUSINESS DAYS <br /> DATE a�ifo3 <br /> SIGNATURE OF APPLICANT t Deoarbnent Use Only <br /> UNIT <br /> FILE ADDRESS <br /> G a ❑ unit 1 <br /> t. sveat I�-(J j <br /> 2. Street SIA <br /> G �u ❑ unit z <br /> a. sveet aK _ A/IC�UU 1I <br /> J a 5 <br /> 4. svri G. Krt 1t3 J <br /> s. sveee `i`+o N It <br /> a <br /> s, s�rcei U�(w/N .tir1 LH Unit 4 <br /> r. SIree1 (YLta E G <br /> G <br /> e. atreel ti�� LtaKr/n/ .rt.l�n��F -�' Nt 5 <br /> G <br /> s. Strcn <br /> CI <br /> 10, Slretl <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> O HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> IiZ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) EI DOG KENNEL 13 DAIRY <br /> ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> GJ HAZARDOUS WASTE GENERATOR ❑ MOTELHOTEL ❑ PUMPER TRUCIOYAROICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ P00USPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1, List up to ten addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-0133 or mail to the <br /> address indicated above. ointment for review will be confirmed <br /> 2• EHD will notify the applicant if any EHD flies exist. An(p) Y p Ilcation. The files <br /> approximately five business days but no later than <br /> an ten 10 da s after re ei should pbe a ion- ed <br /> will be held for a maximum of five business days for review. App <br /> accordingly. t bimmediately available for review: A nev <br /> 3. A file that is actively being Worked on by EHD staff may not <br /> application may be submitted when the file is available. ff at the <br /> 4• Any File not returned In the same condition as released illlbe r rg ane aaize by EHD sta0 dept prior exp <br /> ns( <br /> of the applicant. Future file reviews by the same app may req <br /> iev <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 INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 90.0;-0a0 <br /> are„neo IC,rt Gvl/aiil <br />