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?AO <br />—DATE RE_ OE1\1c, El, <br />NitC•(:-).71'0.1 V <br />. _ <br />'yi;ronme nta I Group 91' <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />SEP 2 2 2004 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br />468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin,ca.us/elid <br />PENVII 1 <br />vc A APPLICANT: BUSINESS/AGENCY: <br />7 4 G nrcfc-VS(Jc, (:),;11z Pkt <br />ADDRESS: <br />PHONE: 6714 q 2 1 - C, o <br />PUBLIC RECORDS RELEASE APPLICATION <br />APK- CotiWwikq'tei E t ibup <br />6cif-46 ()'O' <br />FACSIMILE; <br />czctli (1,14 ("/- 'if() 3?) <br />866B8 <br />_ <br />P.01 <br />EHD LOG M./MED <br />ttv <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allovi 10 business days from date of application submittal) <br />I:1 CHECK BOX TO EXPEDITE REQUEST - $0.00 FEE — REQUEST PROCESSED IN 3BUSINESS DAYS <br />SIGNATURE OF APPLICANT (4r 4)/za DATE `//2 2/6 4 <br />Department Use Only <br />UNIT <br />FILE ADDRESS <br />Street 1711 'it9c-v4l1tc, " -711- oty <br />1 <br />2 Street 20(,0 g?)t- •iti)cM4i 1•C cuy <br />City <br />3. SL <br />Cl <br />4 <br />5 <br />Street <br />Siws City <br />6 Safe! <br />7 Street <br />8 Slreel <br />City <br />9. street <br />City <br />10 Stre.,1 <br />Jo <br />N 4/1-c r rad I u <br />cit <br /> <br />fisSivtir we% 4;1 <br />T"\ <br />C. <br />El Unit 1 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES 00E10000 SOLID WASTE FACILITY <br />SOLID WASTE VEHICLE <br />DAIRY <br />PKG TR5ATmENT PLANT <br />PUMPER TRUCK/YARD/CHEM TOILETS <br />LAND USE APPLICATION SITES <br />Cle UNDERGROUND TANK (UST) CLEANUP StTE (LOP) <br />CV OTHER CLEANUP SITE (NON-LOP) <br />IV UNDERGROUND TANK (MON1TORING/REMOVAL) <br />HAZARDOUS WASTE GENERATOR <br />TIERED PERMITTED FACILITY <br />TATTOO1BODY PIERCING <br />MEDICAL WASTE FACILITY <br />HOUSING ABATEMENT <br />FOOD FACILITY <br />DOG KENNEL <br />CHICKEN RANCH <br />MOTELJHOTEL <br />POOL/SPA <br />OTHER (PLEASE SPECIFY) <br />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 1209) 464-0138 or mail to the <br />address indicated above. <br />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. 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 />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 <br />review. <br />*TENTATIVE appointment dates Must be confirmed with EHD staff. <br />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 />YES NO REVIEW DATE _ <br />0-0 48-02406 <br />siv1003 it9-1-0(-1 Il II C5171i '-oiq 0A-f-1-0 <br />REVIEWED