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\/04/04/2005 15:53 2093694' I NEIL ANDERSON EN` ,O PAGE 01/0 <br /> ` GATE RECEIVED EHD LOG h '.ER <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL.HEALTH DEPA- a 11k <br /> 304 E Weber Ave 3`d Floor Stocktaau(� <br /> (209) 4683420 Fax: (209) 464-01.38 Web: WWW.c01RA-j <br /> r SAN JOAQUIP4 OUNT <br /> PUBLIC RECORDS RELEASEpifflIf ! <br /> —, <br /> APPLICANT: BUSI^NESSIAGENCY: Q� <br /> ADORE5S: - II srd �.�� 'V l� l.L��� cam{ _c-A (91f)a`[J <br /> PHONE: �"1 -' �1�0�` ` FACSIMILE: 36%— '1�� l <br /> TENTATIVE*APPOINTMENT DATE: _Time: <br /> (Please allow 10 business days from date of application submittal) <br /> 12 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department USe On <br /> A1 I r FILE ADDRESS UNIT <br /> I V/I' 1. slrrrl �_ ' Q11 <br /> Isla' 2. slrecl cltY A_— r] unit , <br /> i 1 3. Streel�- Ir ally � C <br /> f-NII Unit 2 <br /> �� �. Slretl CII <br /> s. sheet CITY-- _ UnPul <br /> 10 <br /> G. Street _ Ol <br /> 2 <br /> 7. Strrat CE, no <br /> ' Cit <br /> Un <br /> 9. Slreel 01 <br /> 9. Strrrl - C"y Unit 5 <br /> 10. Slrccl G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES . <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LAP) GI HOUSING ABATEMENT SOLID WASTE FACILITY � <br /> �OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 135OLID WASTE VEHICLE <br /> UNOERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL M DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 11 PUMPERTRUCKNARD/CHEM TOILE <br /> ❑ TATTOOIBODY PIERCING ❑ POoiJSPA D LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY In OTHER(PLEASE SPECIFIC <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checl, <br /> the appropriate box(es). At least one file type MUST be selected, Fax to (209) 464-0138 or mail to t_ <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 fil <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 0 <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 staff at the expo <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to rev <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 /> CONFIRMED APPOINTMENT DATE _ � TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />