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WAY. 18. 1004- 2: 0 8 P M "TGOMERY WATSON NO. 923EHDLP, 1UMBER <br /> DATE RECEIVED SAIN JOA.QYJL COUNTY <br /> .s I�� �� EEl�v][RONNTaL H�AL l DEFA xTMEN'z <br /> 304 E Veber Ave 3T'Floor Stockton, CA 95205 <br /> MAY 1 8 2 69)468-•3420 Fax: (209)464-0138 Web: VrVMCO.San-joaquin.ca.us/ehd <br /> r�\li;.a11T��E�1T <br /> HEALTH PLTSX,IC RECORDS RELEASE /APPLICATION <br /> t/ BUSINESSIAGENCY: <br /> APPLICANT. <br /> - vs CF,vw G <br /> ADDRESS: Z� <br /> : FACSIMILE: <br /> PHONEa b S 6 v I <br /> Time: � <br /> TENTATIVE*AFpOINWENT DATE: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$g3.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS /� <br /> PATE <br /> SIGNATURE OF APPLICANT t�o,tvn nt Use Only <br /> UNIT <br /> FILE ADDRESS <br /> ,. 5 t ' `�C�O �r ✓� Unit 1 <br /> C <br /> S�oG� o✓t o� p <br /> G <br /> z s S L Unit 2CA <br /> �-v <br /> 3. S' a <br /> a. s <br /> S, � c>ti 3 'I <br /> s. s t '1 a, Ala <br /> 6. street Z o✓� ` Unit <br /> 7. stbet i'l0o p <br /> � CL <br /> a. Unit 5 <br /> 9. S et 9 <br /> 0. SVeet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> $f UNDERGROUND TANK(UST)CLEANUP SITE(LOP) p FOOD FACILITY [3SOUD WA5TE VEHICLE <br /> O OTHER CLEANUP SITE(NON-LOP) G KENNEL M' DAIRY <br /> ❑ DO <br /> 9 UNDERGROUND TANK(MONITORING/REMOVAL) ❑ O GKEN RANCH CIPKG TREATMENT PLANT <br /> 0-HAZARDOUS WASTE GENERATOR C1 MOTEUHOTEL ❑ PUMPER TRUCKIYARD/Ct1EM TOILETS <br /> 0 TIERED PERMITTED FACILITY p PooUSPA ❑ LAND USE APPUCATION SITES <br /> C1 TATTOOIBOpY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACIUIY <br /> above- Select the type(s)of files from the list above by checking <br /> 1, List up to ten addresses in the spaceFax to {209)464-0138 or mail to the <br /> the appropriate box(es). At least one file type MUST be selected. <br /> address indicated above, ointment for review will be confirmed <br /> 2. EHD will notify the applicant if any EHD files exist. An app <br /> da s after receipt of application. The files <br /> approximately five business days but no later than ten( ) y ointments should be scheduled <br /> will be held for a maximum of five business days for review. App <br /> accordingly. not be immediately available for review. Aneµ <br /> 3, A file that is actively being worked on by EHD staff may <br /> application may be submitted when the file is available. reorganized b EHD staff at the expense <br /> a. Any file not returned in the same condition as released <br /> lmay require a$93.00 deposit prior to review <br /> of the applicant. Future file reviews by the same applicant <br /> must confirmed wth EHD staff. <br /> 5. *TENTATIVE appointment <br /> ates pm will <br /> be pro essedlt a ext business day. <br /> 6. Applications received after <br /> pg <br /> DATE DONi"In�r>+p' ,� L,. r �i ;,c .�• <br /> RE�f11=WDUS " Nb' <br /> EHo 48.02.006 <br /> 8/82003 <br />