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FROM : ENGEO INC TRACY, CR FAX NO. 209-835-0675 t. 31 2003 11:55AM P1 <br /> r: <br /> GATE REC--IVE] EHD LOG NUMB <br /> f SEAN JCAQM COUNTY <br /> ENV IRC)NiYIENT'AIALTHDrPARTNI :NT <br /> r <br /> 304 E Wcocr Ave Yd Floor Stockton, CA 95205 <br /> ��0 ! '� '!") 9) 468-3420 Fax: {209) 464-0138 Wets:w�vw.co.san joaquin.ca.us/ehd <br /> 1. UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; SF' f,,f15E 13USINESSfAGENCY;_. <br /> ADORESs: �O_.N ��cY_ �,� L � ACY'� C'fl �� 3 7t< _ <br /> PHONE: aQ�"5315 0610 FACSIMILE: - 209^$3!5 - OS76 <br /> TENTATNE'APPOINTMENT DATE; Time: <br /> (Please allow 10 business days from date of application submittal) <br /> 1 CHECK BOX TO EXPEDITE REQUEST-$93-00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �i.,�' �?;( r-- DATE _ya13/1'63 <br /> " Department Use Onty <br /> fL FILE ADDRESS UNIT <br /> O f E POO G Unit 1 <br /> 3. pet Yds 7 u city Unit 2 ., <br /> 1; Mr= �,?• CIN - <br /> 5. SI cl ��yy <br /> .72 <br /> b QPit, <br /> I 6. SVe 19 / r` -- -- ��714-0 a Q V <br /> f r. so-�ti Hsi O G „// <br /> a. street r iii AP0 7 W Y I11 U . hu <br /> 9. Sveet [� 7 IeJll JO O !� 1 10. Srre-t ✓j ew?7 .,60,1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WASTE <br /> 1 � yyylll <br /> OT1i1=fi CLF SITE(NON LOP) f=00!}FACILITY SOLID WASTEikHIQLM!1' ' <br /> UNDERGROUND TANK(MONITORING/REMOVAL) DOG KENNEL 9 DAIRY <br /> HAZARDOUS WASTE GENERATOR , CHICKEN RANCH Q PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY C7 MOTELIHOTEL 0 PUMPER TRUCWYARDICHEM TOILETS <br /> ❑ TATTOOIgODY PIERCING 0 POOUSPQ LAND USE A>'PLICATION srms <br /> MEDICAL WASTE FACILITY 9 OTHER(PLEASE SPECIFY)�� [rteAllf764 E APP I C <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. Pax 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 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 rec(Uire 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 APPOlNTMFzNT'DATE TIME <br /> DATE CONFIRMED PHONE PAX' IN1171ALS <br /> REVIEWED YES NO REVIEW DATE <br /> En048.02.00s <br /> ararxoas "' <br />