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11/20,200 09:59 FAX 416041 TRGAWtELL & ROLLO 14001 <br /> 11/19/2003 14:49 46*8 <br /> DATE RECEIVED"� ENVIRDNMENTAT HEALTH PAGE 02 <br /> (� 1 1//I[-•l JAN�JOA UIN COUNTY EHULOG NUbNLf <br /> EN,'IRONMENTAL HEALTH DEPARTMENT <br /> NOV 2. 0 2003 304 E Wcbcr Avc 3ra Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209) 464-0138 Web: www•co.san joaquin.ca.us/ehd <br /> ENVIRONMEiI,i l I ILALi i; <br /> PERMIT/SERVICES r 'PUBLIC RECORDS RELEASE/(APPLICATION <br /> APPLICANT:�GuLI(�`• ✓IY.J� BUSINESSIAGENCY: <br /> W O <br /> ADDRESS:_SSS Ao,,j Gtvtit Psi I ,-�, �1 I-zv1 LC G u <br /> PHONE: LI15 5eG go ---FACSIMILE:—.-. Lf(S 5 J 4O <br /> TENTATIVE'APPOINTMENT DATE:— ///26 /03 Z Time: qf ooi- <br /> (Please allow 14 business eays'ffem dale of gpPliCation submittal) <br /> C9 CHECK BOX TO EXPEDITE REQUEST-5 00 EE-/p,£QUI�ST PROCESSED IN,7:.,. 4 <br /> ESS DAYS <br /> SIGNATURE OF.APPLICANT <br /> Department Use Only <br /> FILE ADDRESS - UNIT <br /> 1. SlrlM Z r CII <br /> CI A ❑ Unit 1 <br /> 7. Slreel <br /> Unit 2 ll' <br /> 4. 91Re1 GI i� <br /> B. strlH GI _ <br /> r. $IIP<I <br /> Gly <br /> . . o <br /> e. $V901 GI <br /> 9. Slrcl1 C,1 <br /> Unit 5 <br /> te. Svnl GI <br /> .../// ENVIRONMENTAL HEALTH DEPARTMENT FILESRIV <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT - O $OLi1j WASTE FACILITY:.:,. <br /> OTHER CLEANUP SITE(NON-LOP) - O FOOD FACILITY - "❑ 30❑D WASTE VEHICLE <br /> �(UNDERGROUND TANK(MONITORINGIREM OVAL) ❑ DOG KENNEL ❑ DAIRY <br /> G HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WA5TE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list abc ye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mall 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 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 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 OuNo t p 'or e e <br /> S. '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 /> EHD 1B•03•o06 - <br /> erdzoos <br />