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04/05/2006 15:56 FAX 2002/002 <br /> DATE RECEIVED40 env wv •,.... <br /> Sa1`i JOAQUL`i COUNTY <br /> WECER / ED ENVIRONMENT-0,L HEAJ TH DEPtaRTMVtT <br /> 304 E Weber Ave 3" Floor Stockton, CA 95205 Z��S <br /> At,f; 6 {00�209) 468-3420 Fax: (209)464-013$ Web: vnvw.cosan-jcagtzin.ca.uvchd _t <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE .UPLIC: nbN4 <br /> APPUCANT: r�{, r;g ` .L•-�� 6US1NES5fAGENCY: �l 1�9I�1 E': -; <br /> ADDRESS: C <br /> PHONE: jn FACSIMILE:SI <br /> TENTATIVE'APPOINTMENT DATE: -(/I gz6-11 Tune:,, <br /> (Please avow To bvainess days from date Otapplit 6040 submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-583.00 E RF VEST PROCESSED IN 3 BUSINESS DAYS �..� <br /> SIGNATURE OF APPLICANT - � — DATE 11_-��t;f--i�—.� <br /> Oepanment Uac Only <br /> ! DDRESSILE AUNIT <br /> 6-5"7-] i•� ti1-I•T4 © Units <br /> r. <br /> Unit 2 I11 <br /> a. Stmci .• �� __ 1 <br /> s nH Unit 3 <br /> 6, 54md CI ` <br /> r. Sv . _ a. y�.Unit 4 <br /> 1. r+bM <br /> e, avati ❑ Un;t 5 <br /> chy <br /> m. sYaa <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNOERGROUNO TANK(UST)CLEANUP SrTE(LOP) ❑ HOUSING ABATEMENT fzLSOLID WASTE FACK.M <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK{MONiTORiNGIREMOVAL) ❑ DOG KENNEL 9-DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 8-PKG TREATMENT PLANT <br /> C) TIERED PERMMEO FACILITY ❑ MOTELhiOTEL ❑ PUMPER TRUCKIYARDfCHEM TOILETS <br /> ❑ TAT10OA300Y PIERCING 0 POOLrSPA to LAID USE APPLICATION SITES <br /> ❑ MEDICAL WAST£FACILITY ❑ OTHER(PLLASE SPECIFQ_•,,,, ---�-- <br /> 1. List up to ten addresses in the space above. Select the type(s) of rites from the list aboye by checking <br /> the appropriate box(es). At least ono`ilc type MUST be selected. Fax to (-D91 464.0138 or mail to the <br /> addres.indicated above. <br /> 2. EHO will notify the applicant if any EHD files exist An appointment for review wilt be confirmed <br /> approximately five business days but no later than ten (10) day% after receipt of application. The files <br /> will be hold 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. Anew <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 stats at the expense <br /> of the applicant, Future file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> 6. '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 /> I.GUNF(RMED.QP.POINTfdENTdATE .' r .i'%"x:.:�.:�. TIME '"kr;:+k�.'.'•`::`2:� �"j'� ' <br /> : :. i ..I :.• . <br /> DATEGONFiRMED ;PHONE . FAX '.; •".;:vim:,,-; .(TIALS <br /> P.F_VIEV/ED YES NO REVIEW DATE' r :. <br />