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X002 <br /> _ nU26/2004 13:04 FAX 209 94806 <br /> DATE RECEIVED SAN JOA,QUIN COUN7Y <br /> t� E�RONENTAL HEALTI3 UEPARTMENT <br /> 304 EWeber-Ave 3`d Floor Stockton,CA 95205 <br /> _ J U L 2 6 20Q0209)468-3420 Tax: (209)464-0138 Web- � s�joac�uin.caus�chd <br /> ENVIRONMENT HEALTH pUj3I,IC RECORDS RELEASE AHLICAUON <br /> P <br /> AppL1C4AXT: <br /> ADDRESS: <br /> 6 <br /> FACSIMILE: g K d Z r <br /> PHONE: / <br /> TENTATIVE'APPo1NTM <br /> ENT DATE:--d Time: <br /> (Ploaso allow 10 beasiness days from date of application submTtfA <br /> Q CHECK$OX TO EXPEDITE REQUEST-$'3.00 FEE--REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT Departff nt Use Only <br /> UNIT <br /> FIl E ADDRESS <br /> Unit, <br /> 2. sc� it S- Unit 2 {J� <br /> 3- 9ioat tCS� � -ST 6 <br /> 4• sates Unit 3 <br /> 5sked <br /> - <br /> e: sweet nit 4 <br /> 7. sued <br /> a. SowA Q Unit 5 <br /> 9. S&ca <br /> ,0. d <br /> ENVIRONMENTA-HEALTH DEPARTMENT FILES <br /> CLEANUP SCIE(LOP) ❑ HOUSING ABATEME tr IS SOLA WASTE FACILITY <br /> Ito UNDERGROUND TANK(UST) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ DOG FENNEL 19 DAIRY <br /> qt UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH 13 PKG TREATMENT PLANT EM TO(L M <br /> Q Hq�poUS WASTE GENERATOR ❑ MOTELA40TF-L ❑ PUMPERE APPLIYAF( N <br /> ❑ TIERED PERMrMD FACILITY ❑ poOVSPA $ LAPID USE ppPUCATION SITES <br /> ❑ TATTOMODY PIERCING p OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1. Last up to ten addresses in the spaces above. Select the types)of files from the list abode by checking <br /> the appropriate boxes). At least one file type MUST be selected. Fax to 209 46.4-0138 or mal(to the <br /> address indicated above- ill be confirmed <br /> Z EHD will notify the appiicatlt ff any EHD files exist M a10 <br /> ointment <br /> eceipt of ldon. The fi <br /> approximately five business days but no later than ten(10)days aft <br /> nents shoo dplibe scheduled les <br /> will be held for a maximum of five business days for review, App <br /> accordingly. EHD staff ma not be immediately available for review. Anew <br /> 3, A file that Is actively being worked on by Y <br /> application may be submitted when the file is available. at the expense <br /> a. Any file not retumed In the sam b the same applicantdition as released will be reorgan <br /> may require a$93.00!zed by xdepos t Prior to reviewof the applicant- Future file reviews Y <br /> 5 *TENTATIVE appointment dates must be confirmed with EHD staff, <br /> g. Applications received after 3:00 pm will be processed the next business day. <br /> : . . TIME <br /> �C«NFRMIED POlNTM1=NT <br /> E <br /> 1jA7 <br /> A,1?- ,IN•tTJ, <br /> `:1.. .1 PHONE FAX <br /> 1) E.GpNF1RIAF-D <br /> (REVI•E1NED YES.- ND REVIEW DATE - <br /> starzOaa . <br />