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pit "'.(THU)SEP 16 2004 13: ^ 13 :42/No. 6812855736 P <br /> ��AFEIRE`CEIVED EHD LOG NUMBEI <br /> SAN JOAQUIN COUNTY <br /> SEP 1 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIR0N1`V1E IE- ' 304 E weber Ave 3ra Floor Stockton, CA 9S205 <br /> PERP, /SES`��i_+ 1�)468-3420 Fax: (209)464-0138 Web:www.co.san joaquin.ca us/ehd 001,40 <br /> / IPUBLIC RECORDS RELEASE APPLICA.'Z'ION <br /> APPLICANT: .�feUG CiJP,�td&PtDV) BUSINESSIAGENCY: CO�ve/"S� CG�su/qtr <br /> ADDRESS; q10p3V «/IF fe �/UG <br /> PHONE: /O/ ' 79�- Q� FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: 99 �� Time: <br /> (Please allow 10 buslness days from date of applioatidn submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93,00 F7jZ?ff�ED IN3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT , _ DATE YZ IOy <br /> 1 11 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> s,,�, 37Lt9 ht/I7ihS ❑ Unit 1 <br /> 2. street Z rAC,-TV0e 5 CW , <br /> a. st+� ❑ Unit 2 <br /> .. $VV6 <br /> s. Street �Unit 3CO-- j:X <br /> ti. street <br /> 7. sow city Unit 4 <br /> e. mel+ City <br /> a S,„e1 G ❑ Unit 5 <br /> 10, Street <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> IKUNDERGROUND TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATEMENT U SoLtD WASTE FACILITY <br /> EX OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> i�UNDERGROUND TANK(moNITORINGREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH Q PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY D MOTEUHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOl800Y PIERCING O OOUSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY) toymyll <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. END will notify the applicant If any EHD fifes 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 file that Is actively being worked on by EHD staff may not be immediately available for review. A nev <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 reviev <br /> 5. *TF.NTATIVE appointment dates must be confirmed with END staff. <br /> 6. Applications received after 3:OD 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 /> env*wzooa " <br /> einrzooa <br />