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04/05/2006 13:27 FAX la 001/001 <br /> DATfi RECEIVED �"�' Cr,,.••••• <br /> SA--j JOAQt1L^f COUNTY <br /> � ��� 'D E`IviRONMENt TAL CLCA.LT DEPA.RTMEPiT <br /> 304 E Weber Ave 3 d Floor Stockton, CA 95705 <br /> APR. 0 CWS)9) 468-3420 Fax: (209) 464-0138 Web: w�nv.cosan-joaquia.ca.usret d <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATTO:N, VVV `- <br /> �•.FpM1AlTiccrztn. rrc = <br /> APPLICANT: f��x� 7 1/C�.S BU$INESSIAGENCY:--4!�j t-IN <br /> ADDRESS: JS )`�((n:' •,• .- 5� SI'X �-C11gAf <br /> PHONE: ?,0. 0I Z� / (�I S�� FACSIMILE: � �°Z <br /> TENTATIVE*APPOINTMENT DATE: 4l1 5/ht Tim-: <br /> (Pleas-allow 70 ba+ iness days from date of application submittal) <br /> C3 CHECK BOX TO EXPEDITE RFOUE T^•5093.00 EE EOUEST PROCESSED IN 3 BUSINESS DAYS �f <br /> SIGNATURE OF APPLICANT -. DATE .G✓ <br /> ' pepartrnentthe D,Jv <br /> UNIT <br /> FILE ADDRESS <br /> nit I e, <br /> Unit 3 . <br /> ]. su <br /> C <br /> LI3f0 S• ft « n1 G* Unit4 <br /> s. s,�..n Z. �to S• S'� IZT 5�r [] Unit 5 <br /> ,. s.. �Z'iG E, t-Ur,Pos-G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE tLOM O HOUSING ABATEMENT LQL SOLID WASTE FACILITY <br /> OTHER CLEANUP STYE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> a UNDERGROUND TANK(MONfTORINGIREMOVAL) ❑ DOG KENNEL E-DAIRY <br /> X HAYARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O-PKG TREATMENT PLANT <br /> ❑ TIERED OtIsPERFACILITY ❑ MOTELlI10TEL ❑ PUMPER TRt)CKryARbICHEM TOILETS <br /> ❑ TATTOO/DOOY PIERCING 4 POOLtSPA w' LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACII.TrY ❑ OTHER(PLEAZE,SPECIFf)—�..�,...--•--- <br /> 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 rile type 141UST be selected. Fax to (202L,a6d-013f: or mail to the <br /> address indicated above. <br /> 2. <br /> EMD will notify the applicant if any EHD files exist. An appcintment for review will be confirmed <br /> approximately Five business days but no later than ten (10) day"' it of alp be s heduhd <br /> will be held for a maximum of five bufiles le <br /> siness days for review_ <br /> accordingly. <br /> A file that is actively being worked on by EHD staff may not be immediately available for review. neer <br /> application may be submitted when the file is available. f at the <br /> 4. Any file not returned in the same condition as released cant mayreorganized <br /> a by EHD stat t prior to P view. <br /> ense <br /> of the applicant. Future file reviews by the same app Y <br /> 5. -TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will ba processed the next business day. ------ - <br /> CQNFI,RMED APPOINTMENT DArE �� TIME -' <br /> 1NFTIALS T ' <br /> DATE CONFIRMED PHONE FAX <br /> F;EVIEL":ED YES NOREVIEW DATE <br />