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0 0 (ANTE RECEIVED jJ(� (� SAN JOAQUIN COUNTY MD E � E r � �V (� `' �J ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Ave 3ra Floor Stockton, CA 95205 AUG 13 20W9) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd .� . I•I I IN 01 N EHD LOG NUMBER IYM —TLA-17V11I/OLI1VIVLJ APPLICANT: KiKAN �iA-c kF—Aj0 BUSINESS/AGENCY: 5,r4A-7yS ��IyidoNMENiAt_, iavc, ADDRESS: 330 (,f}thElCOr) ,PARK. IDK., '-fy SS� CAYri�KOtJ �/�iQX GPr 115;63 2— PHONE: 530 62f- 600 -4 FACSIMILE: 530 4�6 600s t TENTATIVE* APPOINTMENT DATE: Q 113 f 0 1+ Time: Is: 00 ti�a (Please allow 10 business days from date of application submittal) � (L CHECK BOX TO EXPEDITE REQUEST - $FEE — REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT rn6w N "'- DATE ®a 11-3 10(P �T el2 Department Use Only UNIT ❑ Unit 1 ❑ Unit 2 -4�q 3) je Unit 4 ❑ Unit 5 ENVIRONMENTAL HEALTH DEPARTMENT FILES — UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE UNDERGROUND TANK (MONITORING/REMOVAL) E3 DOG KENNEL ❑ DAIRY E3HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH 13 PKG TREATMENT PLANT TIERED PERMITTED FACILITY 13 MOTEL/HOTEL E3 PUMPER TRUCK/YARD/CHEM TOILETS O TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES 13 MEDICAL WASTE FACILITY 17 OTHER (PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. 5. *TENTATIVE appointment dates must be confirmed with EHD staff. lqh 6. Applications received after 3:00 pm will be processed the next business day. 04 --RU4 - CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED RHONE .' FAX. INITIALS REVIEWED YES NO REVIEW DATE 8!8!2003 2A06 � /7-D�l� l2 k/' a�25 Lour M�t(,{,!/�-iiZ f7�i✓l "�'G/�'/'. K� FILE ADDRESS 21 Z S Go V N 1 LM c.U=C 8 LAt4 t' atyS'f o t-KtT OYV ✓. 1. street 2. Street 2.5 1-5* ---- �t' r4ty•' s. street 2-15 i aty T 4. Street atytI 5. Street a tv 6. Street a ty T. Street a ty a. Street c jty 9. street ON 10. Street a t. Department Use Only UNIT ❑ Unit 1 ❑ Unit 2 -4�q 3) je Unit 4 ❑ Unit 5 ENVIRONMENTAL HEALTH DEPARTMENT FILES — UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE UNDERGROUND TANK (MONITORING/REMOVAL) E3 DOG KENNEL ❑ DAIRY E3HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH 13 PKG TREATMENT PLANT TIERED PERMITTED FACILITY 13 MOTEL/HOTEL E3 PUMPER TRUCK/YARD/CHEM TOILETS O TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES 13 MEDICAL WASTE FACILITY 17 OTHER (PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. 5. *TENTATIVE appointment dates must be confirmed with EHD staff. lqh 6. Applications received after 3:00 pm will be processed the next business day. 04 --RU4 - CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED RHONE .' FAX. INITIALS REVIEWED YES NO REVIEW DATE 8!8!2003 2A06 � /7-D�l� l2 k/' a�25 Lour M�t(,{,!/�-iiZ f7�i✓l "�'G/�'/'. K�