Laserfiche WebLink
May. 19. 2005 12: 14PM AMANCED GEO No. 0611 P. 2 <br /> SAN d OAQM CO UNTIE £HD LOG NUM81rR <br /> ENMONMENTAX;HEALTH DEPARTMENT � <br /> MAY 1 9 20053 304 E Weber Ave 3rd E100r Stockton,CA 95205 <br /> E p,ONMENT HEAR)li)468-3420 Fax: (209)464-0138 Web:www-co-san-joaquin.ca.us/ch <br /> joaquin.ca.us/ch <br /> PEROTISERVICES p LIC RECORDS RELEASE APPLICATTON <br /> dVan } 6�_/� L <br /> APPLICANT Z�I ��+I'y�,,,UsfN£53fAGENCY/��ry C@rOt VJ47lUJhD/I �fit 1. <br /> ADDRESS: J I LJc 4/�l7b //fir] <br /> PHONE: Q FAGSIMILE: �/ <br /> TENTATIVE'APPOINTMENT DATE; ' dy <br /> Tuna: r <br /> {plaatu r.11aw O 1 d m da apPli n submitIAI) <br /> n0 FAQs re 36 <br /> CHECK 84X TO EXPEDITE REQ T- 93.04 EE-E T PRO IN USINEss.DA" (A <br /> f <br /> SIGNATURE OF APPLICANT 'DATE 51, ,' <br /> Dapa+t hent Use Only L/N <br /> FILE ADDRESS UNIT <br /> Saeec MV <br /> .2 s,eet _ ❑ Unit 1 <br /> fV r F1 4. s� ❑ Unit 2 <br /> 6. menet _ Unit 3 J <br /> 7. so-W 0 t` Unit 4 M <br /> a stMe <br /> 9. SMpN <br /> 10. sneer CRY ❑ Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON4-op) ❑ Pool)FACILITY 0 .9QUD WASTE VENGLE <br /> UNDERGRouND TANK(MIIONITORINGIREMOVAL) 0 DOG KENNEL CJ'DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH d PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY O MdOTELlHOTEL 0 PUMPER TRUGMARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ' b LAND USEAPPLICATION sITE$ <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLUW E 5PEcl <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(2091464-0138 or mail to the <br /> address Indicated above. < <br /> 2. END will notify the applicant if any EHD tiles 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 Wonted on by EHD staff may not be immediately available for review. A new r <br /> application may be submitted when the fl#e is available, <br /> 4. Any file not r•sturned in the same Condition as released will be reorganized by END staff at the expense <br /> of the applicant. Future file reviews by th0 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 /> CQNFIRMED'APPOINThkE ' DATE :7jIVlE <br /> DATE CONFIRMED PRONE FAX INITIALS _ <br /> 7:7- <br /> IRVIEWED 'YES NO - :REVIEW DATE <br /> No 4s.ax-0" <br /> SWIM <br /> k <br />