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08/19/2003 13:03 2094671118 AGE STOCKTON PAGE 01/01 <br /> DATE RECEIVED - '! `9 tl'1U LUV NUMbtK <br /> SAN JOAQUIN COUNTY, <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> NUG 1 9 ?003 304 E Weber Ave 3'a Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209) 4640138 Web: www.co.sa I joaquin.ca.us/,liu I <br /> E',LFti <br /> rs i 1'i:5 <br /> PqBLIC RECORDS RELEASEAPhPLICAUO <br /> APPLICANT: BUSINESSIAGENCY: G�Q. l�ilUi/0/7n'Jt?J? i L <br /> ADDRESS: 83 w Da Stoc & /�J �y J <br /> PHONE: 0(X907• 411p /• /QIp DFACSIMILE: Qo?0 . 7lO 7 <br /> TENTATIVE-APPOINTMENT DATE: e1- 0 f2 <br /> Time: JD=00 <br /> (Please allow to business days from date of application submittal) <br /> ,y I <br /> CHECK BOX TO EXPEDITE REOU 93.00 FEE—REQU S PROCESSED IN 3 BUSINESS DAYS Q P <br /> SIGNATURE OF APPLICANT F�� � DATE <br /> Department Use Only <br /> FILE ADDRESS 'rt UNIT <br /> 1. Sheet —77,5-6 G-'00 /� ON _ AI 3 <br /> `U <br /> 2. Sheet 7 erQr hOr [j unit 1 <br /> J. Sheet CLV P <br /> ❑ Un1t2 <br /> Unit 3 <br /> e. alme cityli J <br /> 7. Sneer city <br /> Unit 4 <br />' e. 9nee1 d As 3fre° o nit 5 <br /> 10. Street cityII i <br /> I <br /> I <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1= I <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY I; O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ij ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH - ❑ PKG TREATMENT PLANT <br /> ❑ TIEREO PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATT001BODYPIERCING . ❑ POOL/SPA s ❑ LAND USE S <br /> U APPLICATION SITE <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) I' <br /> Y <br /> 1. List up to ten addresses in the space above. Select the type(s),of tiles from the list above by checking i <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 be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review, Appointments should be scheduled <br /> accordingly, <br /> 3. A fire that is actively being worked on by EHD staff may not be immediately available for review. A 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 reorganized by END staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <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. 1NITIA <br /> REVIEWED YES. NO <br /> REVIEW DATE - <br /> etlo.0 -0ac <br /> II <br />