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i <br /> AUG'. V. IUU4 4,4UFM NDUK EARN TECH #� NO. 6355 P. 1 : <br /> DATE RI=CENED <br /> SAN JOAQM COUNTY EHD LOG NUMBER <br /> ENVMONMENTAL FIEALTH]DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> AUG 2-7 ZVO)468-3420 Fax, (209)464-0138 Web:www-00-Salo joaquin,ca.us/ehd <br /> 4\AE� HEALTH PUBLIC RECORDS RELEASE.APPLICATION <br /> CAN7: � 4,.f'f �l-k� �tttttttt­$ DUSINESSIAGENGY: <br /> ADDRESS: <br /> PHONE: O9 ^ 2 -,Ova FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: /O 5v gdyL61- 2-00s -rime,: 6 O AAA <br /> (Please allow 10 business days from data of appllcatfon submittal) <br /> CHECK sOX To EXPEDITE REQUEST-$93.00 FEE RE EST PR ESSED IN S BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 17- <br /> DwartmJ <br /> Use Only <br /> FILE ADDRESS ii rr UNIT <br /> 1, 81re91 . t Gf l04fG <br /> z s S S� !a l -..� .,r, a ifs E ❑ Unit 1 <br /> ,. sum -* Unit 2 <br /> (-7 <br /> if 44 �63 Unit 3 Un4tm oe5 <br /> M4.01 "Or— <br /> s. s resp G� o. ❑ Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) I7 HOUsING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> TXUNDERGROUND TANK(MONrroMNGlREMOVAL) ❑ DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERAI'oR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ?9-TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> A TAY OOIBODY PIERCING ❑_POOLISPA - - -- = _ -0-LAND USE APPLICATION:SITES---"----- <br /> 0 MEDICAL WASTE FACILITY t3 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses 16 the space above. Select the type(s)of files from the list above by cbecldng <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 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 maybe submitted when the file is available. <br /> 4. Any the not returned in the same conditlon 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 /> 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 /> !A itt)IF1FM OIwl <br /> ;,' ;,•, t <br /> ..,, ; <br /> 12 i <br /> D 48-02-006 <br /> d161Z001 <br />