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.06/25/2094 13:52 2094671118 � <br /> AGE STOCKTON PAGE 61/13 <br /> DATE RECEIVED. <br /> 57j)E�l,:�,—� `t j' ^, EHD LOG NUM8ER <br /> vl #;i�/ J SAN,�TOAQUIN COUNTY <br /> RJ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> J U N 2 5 24 304 E Weber Ave 3"Floor Stockton, CA 95205 <br /> ( 09)458-3420 Fax: (209)464-0138 Web:www.Co,san joaquin.cams/ehd <br /> ENVIRDNit4EN T HEALTH <br /> 1712 L L I T, , F S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: didC <br /> ADDRESS: OW <br /> PHONE: Q7 ` ~ FaCSIMILe: <br /> TENTATIVE*APPowTmENTdAT#r: .34-JDA-me 0. <br /> Tlms: <br /> der" 11� <br /> �VCMSCKBOXTOFXPEDI'l-ERECI <br /> (PIaas4 allow 40 bualntaas days irori�date of appllcat;on9uhmlttal?UE - 93,00 FEE RE VEST PROCESSEnJIN 3 BUSINESS BAYS L� <br /> SIGNATURE OF APPLICANT DOTE �p <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> I. strast QC c <br /> z. s i a N a ❑ Unit 1 <br /> e. Street C 0 UnA 2 T!G <br /> s. 57aet S Unit 3 <br /> s. meet <br /> e. sit Unit 4 <br /> et <br /> G p <br /> ni 5 <br /> 10. Sleet G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT CJ SOLID WASTE K 16 <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY. 0 SOLID WASTE VEHIC <br /> UNDERGROUND TANK(MONITORINGIRFMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR M CHICKEN RANCH 0 PKG TREATMENT PLAN.T <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELlHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTooisoDY PIERCING C3 POOLISPA LAND USE APPLICATION SITE$ <br /> 0 MEDICAL,WASTE FACILITY CI OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209464-0138 or mail to the <br /> -address Indicated above, <br /> 2• EHD will notify the applicant if any END 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 BHD,staff may not be Immediately available for review. A new <br /> application may be submitted when the fife Is:availabie. <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 CONFIRMEDs' AL <br /> PHON>= FAX ' INtt'IAC§ <br /> REVIEWED YAWS NO- REVIEW DATE <br /> EN419-02-009 <br /> t!l91ZCE4 <br />