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11/07/2003 16:1-2 9168610430 SECOR PAGE 01/6 <br /> EHL)LULU NUMtstrc <br /> DATE RECEIVED SAN JOAQUII'.N COUNTY <br /> ENV RONMINTAE HE.ALTS DEPARTMENT <br /> �6& <br /> I,41304 Weber Ave 3 door Stockton, CA 95205 <br /> 0 Fax: (209)464-0138 Web:www-co-san-jvaquin.ca.us/ehd <br /> NOV 0 7 2003 PUBLIC pECOPDS RELEASE APPLICATION <br /> rNl1IF-IUN�I T �I�^'T BUSINESSIAGENCY: (LJA� <br /> APPLICA f fV I L 2 <br /> V <br /> ADDRESS: sea 1--1 Y&-cSLF. v- e r�r r n J4 �r1Cr4q . �(D� <br /> PHONE: 0108�1 2 3 FACSIMiLE: C-714 MAI-Gy"a <br /> TENTATIVE"APPOINTMENT DATE: f I//8 - f�Z - Time: jo:w 14.11 <br /> (Please allow 10 business days from date of application submittaq <br /> Q CHECK BOX TO EXPEDITE REQUEST-$93.00 FE —REQ ST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT PATE a�71o3 <br /> Deosr rens Use Only <br /> FILE ADDRESS UNiT <br /> I YNAa ❑ Unit 1 <br /> 2. Street lS- C - +1 city 1 I I 'v3 <br /> 3. Street ❑ Unit 2 I <br /> 1, st-e-t �F My 5 rpm <br /> 5. 8rraet `17 '.TE Gt Kr'b it 3 I/ <br /> 6. Street 4 Llnllv�N rlt'!' City 57aGt�7 �L Ni� ✓✓✓ <br /> Street 07-1" E G P Unit 4 <br /> B. &li8rt KDl J G r C A) <br /> 9. street at nit 5 <br /> 0. Street CI <br /> 1 I <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> 021 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH M PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTEUHOTEL ❑ PUMPER TRUCK/YARDiCHEM TOILETS <br /> C3 TATTOOiBODY PIERCING C3 POOUSPA O LAND USE APPLICATION SriES <br /> ❑ MEDICAL WASTE FACILITY 10 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the lisrabove 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 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 expenst <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to reviev <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 /> EHb 411.02-006 <br /> 818!2003 . <br />