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V 1�11..Ir/i.Jt,fJJ 1 •... <br /> i i-14-2Fjid Id i 16F f l } Kt I w ✓ .. _� <br /> v.a1tMLLL•IVtO . `/ E}1U L.V0HUML3t72 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SMVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCK-TON CA 93202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEAStEJ AfPPLICA(�T. ION e <br /> APPLICANTTr c 1/10'y r1 --BUS1NE=AGJ NCY W �( i I k oz ✓l`' /T I.� O C' L <br /> ADDRESS 3 o 5bu� /,_R -, e uG C-d c '/ r s <br /> PHONE — FACSIN!!LE i7 <br /> /i7 /�` I <br /> TENTATIVE'APP0447`MV NT DATE TIME <br /> Tease gtvt T to 10 buStnmas days from date of application submittal) <br /> 64WI7-5 <br /> CHECK BOX TO EXREDITE REQUEST-X87.00 FEE-REQU T PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS TH13 SIDS EHD STAFF USE ONLY <br /> PRO <br /> GRAAA ELEMENTS S>•ARCH <br /> � a n- res- T('a c�,r - <br /> Ck oV Vv <br /> OIn A le <br /> O LL ,, Dc C <br /> 0 N 61 <br /> S S • <br /> A� ec <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> MIUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATF-HENT O SOM WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LDP) ❑ FOOD FACILITY Q SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ POG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREAT1NEW PLANT <br /> C3 TIERED PERMITTED FACILITY Q MOTELlHOTEL 0 PUMPER TRUCKlYARDICHEMTOILLTS <br /> Cl TATTOOIBODY PEiRCINiG in POOLISPA • 13 LAHP USE APPIJGATION SITES <br /> ❑ MEDICAL WASTE FACILITY Q PUBLIC WATER SYSTEM 13 OTHIER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addrdsses In the space above, Select the type(s) of files from the list above by checking <br /> the appropriate box(e%). At least one file type MUST be selected. Fax to (209)4s4-Q'Ia or mail to the <br /> address ir)diCatgd above, <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmecl <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 tray not be immediately available for review. Anew <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 EFID staff at the expensa <br /> of the applicant. FtlturQ file reviews by the same applicant may require a $87.00 deposit prior to review. <br /> b. '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 13ATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NQ REVIEW DATE <br /> Err o t o rad <br /> TOTAL P.01 <br />