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k' Sep 02 05 09 : 34a piR"" 408 - � 9 - 1224 p . l <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER - <br /> SEP - 2 2005 ENVIRONMENTAL HEALTI3 DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 Q <br /> ENVIRONMENT HAJ 68-3420 Fax: (209) 464-0138 Web: www ,co.sanjoaquin.ca.us/&hd <br /> PERMIT/SERVICES <br /> PU I�nL/gI7C�J�RtE/�CORDS RELEASE APPLL�ICATION <br /> APPLICANT: l 7 00mg- l BUS <br /> INESS/AGENCY: MLS ~dei LlIrU �I /✓10 v� � Ste-✓UI CO C <br /> ADDRESS: /I �J�-yJ-/� S. Aos ♦Co ^s Ay-Q � (^ � Sc�✓L �O S� C/T �l 71D J <br /> PHONE: ITUIS ID`1G —Id-� T FACSIMILE: <br /> TENTATIVE" APPOINTMENT DATE: Time: VI <br /> (Please allow 10 business days from date of application submittal( <br /> CHECK BOX TO EXPEDITE REQUEST - $93 00 €ErE/ REQUEST <br /> .,PROCESSED IN 3 BUSINESS DAYS �Y <br /> SIGNATURE OF APPLICANT V " _ "/�° 00Ap t � DATE _ ` � � -� � <br /> I� & � N U O N � Department Use Only <br /> til t FILE APDRESSS UNIT <br /> I, siree� -Icky ❑ Unit 1 <br /> x. spmti5a4p /N & : Oki <br /> S <br /> a. so- el ck ❑ Unit 2 P <br /> A. s"et iP t C a !� I <br /> S. suael otty 00OUnit 3 �11 <br /> 1. street A Ci - - MW Unit 4 . <br /> s. S"01 m t coO l ❑ Unit 5 <br /> 1D. StreetV. . o <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> .8 UNDERGROUND-TANK(USTICLEANUP SITE(LOPI—O-HOUSING ABATEMENT 171-SOLID-WASTE-FACILITY ----- <br /> -I°rOTHER CLEANUP SITE (NON-LOPJ d FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ,UNDERGROUND TANK (MONrrORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> iJ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL 17 PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLtSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) <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 reviewwill 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 file 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 EHD 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 INITIALS ,I <br /> REVIEWED YES NO REVIEW DATE <br /> END 18-03406 <br />