Laserfiche WebLink
Jun. 2, 2005 2.57PM h 'NCED GEO <br />' No. 0833 P. 1 <br />DATE RECEIVED SAN JOAQUIN COUNTY EHD LOG NUMBER <br />REC E,P D ENVIItoNMElyT Ai. HEALTH DEPARTMENT <br />304 E Weber Ave 3rd Floor Stockton, CA 96205,} <br />SUN 0 2 2pb) 468-3420 Fax: (209) 464-0138 Web: www.co,san-joaquin.ca.us/ehd <br />EVIRONMENT HEWN MILTC RECORDS RELEASE APPLICATION , 7 <br />J*4 <br />D^Ij <br />dh <br />APPLICANT: )+UCLLJIll� I IQ fjU! )!f PUSINESSIAGENCY: <br />©� <br />ADDRESS: Gl J 7 t �u) Road, !yaIC o4l 0) <br />PHONE:_6709' / ` xooz FACSIMILE: <br />TENTATIVE" APPOINTMENT DATE: 6/9 /05- <br />dUar�c e� Gear, �i <br />Time: /V:d uu l <br />(Please lov�usini from of ap II tion submittal) <br />CHECK BOX TO EXPEDITE REQ ST • 93.00 FERE U 7 PRO ESD 1 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES WIF <br />Department Use Only <br />UNIT <br />yr <br />is ❑ Unit 1 <br />❑ Unit 2 <br />Unit 3 <br />fli Unit 4 <br />Unit 5 <br />3 <br />0 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) d HOUSING ABATEMENT b SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VFRICLE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) Q DOG KENNEL 0 DAIRY <br />HAZARDOUS WASTE GENERATOR Ll CHICKEN RANCH LD PKG TREATMENT PLANT <br />TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br />O TATTOOIBODY PIERCING 0 POOLISPA CI LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY 0 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. 00 <br />2. EHD will notify the applicant if any END files exist. An appointment for review will be confirtned <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. P_ <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 �40 <br />of the applicanL 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 />CONORmw APPOi.NTM <br />DATE CONFIRMED <br />I?EVIEWED YES <br />e1W2aQ <br />:NT DATE -TIME <br />PHONE FAX <br />lue <br />.REVIEW DATE <br />INITIALS <br />