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08 / 19/ 2003 13 : 03 2094671118 AGE STOCKTON _ PAGE 01 / 01 <br /> DATE RECEIVED tnU cvv NUMbo n <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT �� <br /> I\ U G 1 9 1003 304 E Web e. Ave 3 d Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax : (209) 464-0138 Web : www"co.san joaquin.ca_us/cn.. I I <br /> P LIC RECORDS RELEASE <br /> ��APPLICAUO ��N J <br /> APPLICANT: BUSINESS/AGENCY: LCUI/Q,hGled (: <br /> ADDRESS: lr o OQ SL� ock o <br /> PHONE: OCD9. y671 1001 FACSIMILE: rX� C� a z �O / <br /> TENTATIVE* APPOINTMENT DATE : Time: JOOD <br /> (Pleasa allow 10 business days from date of application submlttap <br /> CHECK BOX TO EXPEDITE REQ $93.00 FEE — REQU S PROCESSED IN 3 BUSINESS DAYS LA <br /> SIGNATURE OF APPLICANT1-----//� DATE � 14703 17 .r. <br /> / Department Use Only <br /> FILE ADDRESS UNIT 3 <br /> 1 . so-"+ 2 3'.S0 ZGOdM/,S 1<611y� ❑ Unit 1 lei ,a• � `t,,. <br /> 2. 9��ee� '7 har �r city <br /> 3. <br /> aty ❑ .�/ <br /> � n unit 2 <br /> a. Sn"i m'GI cu <br /> slot ( YU • a tn <br /> t 3 <br /> e. Meet oly <br /> 7- ane + e' t 4 <br /> a. Simi Ci <br /> t 5 <br /> +o. Mee+ ci <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NON•LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TA17001BODYFIERGING . ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <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 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 applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> 51 '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 1NffIAL <br /> REVIEWED XES . NO REVIEW DATE <br /> eHou zoos <br />