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�� EHD LUG NUMBER <br /> f f <br /> VELD) <br /> 1 5 <br /> Y <br /> E L fr..� SAII J OAQUTN C O UNTY <br /> 'EN'VJR0NM[ENTFI(. �A)<,,r.l"-i DEPARTMENT <br /> -jN' 0 7 2007 304 E Weber Ave 3Td Floor Stockton, CA 95205 <br /> NV11 Nll;l :�l i {�'09L� $-3420 Fax. (209) 464-0138 Web: rvww.co.san-joaquin.ca.us/ d <br /> FF ,N(T(SER VICES <br /> PUBLIC RECORDS kELEA.SE A.PPLTCA.MN <br /> APPLICANT:_ B US INES S(AG E N CY: IV 0A" o _ +- , <br /> ADDRESS; _ [D7i C --257_c4D <br /> PHONE: 199 7 FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: } ' <br /> (Please allow 10 business days from date of applicatigIll0b — <br /> 10 CHE=CK BOX TO EXPEDITE,REQUEST-$93.00 FEE–REQUEST PROC S SS DAYS <br /> SIGNATURE OF APPLICANT LATE <br /> Department use Only <br /> FILE ADORnSS UNIT <br /> t. sweet �p 15 - Ex /J�-�V &yr_i• � a A-. Q Unit i <br /> ./(k?, .^+Irr:rl �� � .•-1:,i�0kHAAT,., .GIY..---••- <br /> 3. Street E) t✓�l • Cu Unit Z <br /> A, Street 1 {,.., n ry Cil <br /> 5 street I t � 1n.( Crl►'i GL ,K,�•t Gly <br /> _ Unit 3 <br /> �L <br /> 1fe. <br /> s. Svf ?+� � <br /> --get <br /> T. $arealLO <br /> . city t Y .. <br /> R, $lrtx'I 4 �--- ;. Glly --.`1.:� <br /> 9. Sweet CI 0_ -Unit 5-.'r' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOQ') ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> la OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY TO SOLID WASTE VEHICLE <br /> UN1 ERnROUNb TANK(MONITQRINGIREMOVAL) O DOG KENNEL 0 DAIRY <br /> '?E HAZARDOUS WASTE GENERATOR © CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> I_11 TIERED PEIZMITYED FACILITY 11: MOTELfHOTEL Cl PUMPER TRUCKlYARDICHEM TOILETS <br /> 0 TATTOO/BODY PIERCING 1 POOL(SPA 0 LAND USE APPLICATION SITES <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 feast one file type MUST be selected. Fax to 209 484-0138 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 fills <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 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EMD 40.02-00e <br /> manooa <br />