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. Sep-22-0414A:iADIr►v-4;ronmental Group 91E q8. 6688 P .01 <br /> EHD LOG NUMBEF <br /> ATS R� �v��l� <br /> SAN JoAQuIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPA FNIENT <br /> S E P 2 2 2004 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> (209) 468-3420 Fax: (209)464-0138 Web: www.co.san-joaqum.ca.us/ehd 033 <br /> F'r"1'tr" 1'\1iGF1 PUBLIC RECORDS RELEASE )APPLICATION <br /> ` 4F t`1`�I� ==m� BU3INESSIAGENCY: f�V� [yYIIYL��L ViI<i✓' (tlbU <br /> APPLICANT: ICC 1!Gl'u L!h <br /> 17F t^�rc'1 Sl c- C-�1lS Dill C 4- l?.o <br /> ADDRESS: / '' <br /> PHONE: <br /> X14 (72 f - �1t,G(7 FACSIMILE: CtI4 E4�'-t'6 137 <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$a3.-00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> ,l x /Wr DATE <br /> Department Use Only <br /> UNIT <br /> FILE ADDRESS G <br /> 1 Street 1711 e3c>�l 1 Uri1 L�• (571r__ G N lbt �1y ! L� ❑ Unit 1 <br /> I�� _.. 2UF,0 F7>t YaXr�til l c �IL'e <br /> city c <br /> J0 It �lJrl� . z sheet Gy - ❑ Unit 2 <br /> 3 Street <br /> ty <br /> G <br /> s strex ° nit 3 <br /> 6. Street _ G <br /> Unit 4 <br /> 7. sir—i <br /> CM <br /> a ❑ Unit 5 <br /> 9 Sveel �\ <br /> � 10 Street r.; <br /> ty <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> d UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> Lty OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> IV HAZARDOUS WASTE GENERATOR ❑ MOTELRiOTEL 0 PUMPER TRUCIVYARDICHEM TOILETS <br /> 13 TIERED PERMITTED FACILITY p LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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- EHD will notify the applicant if any EHD files exist. An appointment for review will bieconfirmed The files <br /> approximately five business days but no later than ten(10) days after receipt of appc <br /> will be hold 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. Anew <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 review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> fi. 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 /> auez a-z 06 j0 1-pal 11 11 y�s�mi �S i �( Oti f'l rJ�� � <br />