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EHD LOG NUMBER <br /> l SAN JOAQUIN COUNTY <br /> EG ENVIRONMENTAL HEALTH DEPARTMENT <br /> RQq <br /> 304 E Webcr Ave 3`d Floor Stockton,CA 95205 <br /> J U L 27 <br /> ,%Q,))468-3420 Fax: (209)464-0138 Web: www.cO.San-joaquijj.ca.us/chd 1493 <br /> ENVIRONMENT HEALTH w°$ E'Siz <br /> PER�y11TISERVI[ FS PUBLIC RECORDS RELEASE A�'PL�ZD� — <br /> APPLICANT: BUSINESSIAGENCY(:�tr rIA( <br /> ADDRESS: 1� Lllu YV JU-7 �D G�tt'Ifil1T CAIff , till <br /> I Lh G> .3�, FACSIMILE: ��L�' 9'>�'`fib 8 <br /> PHONE:��� <br /> �- <br /> TENTATIVE'APPOINTMENT DATE: <br /> (Please allow 10 business days from date 0 0 Plication su mitral) <br /> —�61CHECK BOX TO EXPEDITE REQUEST 93.00 EE-REQUE T PROCESSED IN 3 BUSINESS DAYS Z7 D <br /> D' a�,rt DATE <br /> SIGNATURE OF APPLICANT ( ((/ Department Use Only <br /> UNIT <br /> FILE ADDRESS _ _ <br /> ❑ Unit 1 <br /> Bill W II;h 5—kL `�-�� ) l ❑ Unit /1 U <br /> 0. Suter U l <br /> n. tiwm_ .. '� <br /> Cdv nit 3 l• '\ <br /> Cly nit 4 <br /> cw -- <br /> cm <br /> Cn '' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> d HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> 'JK UNDERGROUND TANK(USTI CLEANUP SITE(LOP)ND <br /> U <br /> 8t O FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> ER CLEANUP SITE(NON-LOP) O DOG KENNEL O DAIRY <br /> $T UNDERGROUND TANK(MONITORING/REMOVAL) 12 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 12AZ <br /> HAZARDOUS WASTE GENERATOR O /Y <br /> PUMPER TRUCKARD/CHEM TOILETS <br /> p MOTEVHOTEL <br /> ❑ TIERED PERMITTED FACILITY [2 POTELIHO 0 LAND USE APPLICATION SITES <br /> ❑ TATTOOMODY PIERCING p OLISPA <br /> OTHER(PLEASE SPECIFY) <br /> • MEDICAL WASTE FACILITY <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 bec confirmed <br /> The files <br /> approximately five business days but no later than ten(10)days after receipt of app <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 reviewA 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 reorganizedmay require a by EHD staff at <br /> prior expense revew- <br /> of the applicant. Future file reviews by the same applicant <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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE COCONFIRMED <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Ewo ep.ODtb6 <br /> i/820CJ <br /> /,,I (ll,�7 X5(1 SCi��i <br />