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05/01/2003 08:34 209467" 8 AGE STOCKTON PAGE C11/01 <br /> Allit"k EFD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> EN11RONMENTAL HEALTH DEPARTErEl 17T <br /> 304 EAST WE13ER AVENUE,THIRD FLOOR <br /> MAY 0 1. 2003 STOCKTON CA 95202 <br /> (209)468-3420 <br /> i\j ti E \LPU B LIC RECORDS RELEASE AP PLICAT101'4 <br /> APPLICANT hip abe�yl ElUSINESSIAGENCY V LIT=go-L <br /> ADDRESS srocy=K OA 95 1 <br /> PHONE FACSIMILE <br /> 0q) Li 1.11 FL <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 t 10busin"s days from date of application (r <br /> eaLll �� <br /> CHECK BOX TO EXPEDITE REQ -�89.0O FEE-RF_0U7TPROCESSED IN 3 BUSINESS[IAN'S <br /> SIGNATURE OF APPLICANT <br /> ..TE Lf <br /> FILE ADDRESS THIS SIDE_EHD STAFF 1I3E ONLY <br /> PROGFA&I ELE�MENJS SE8ffi&ArAjk <br /> 1 (10)L FF <br /> Pq Land) 03 <br /> II tt It 61 3 n-fir mi r <br /> Ul:1L E: <br /> le tt 4L <br /> kNMI U-4 <br /> SoVA LOI V% IfIv., <br /> M r U) 5 <br /> 51a I yj L4 I noplk, 41101111W <br /> Lac wit, <br /> K"e. oul-140- '''"O"I vt_ <br /> Cop%j suvlk 86 ENVIRONMENTAL HEALTH DIVISION FIL.ES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT 13 SOLE)WA$TE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) �AaAJ�'4 <br /> E3 FOOD FACILITY E3 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 0 DOG KENNEL C3 DAIRY <br /> HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH El PI[G TREATME?47 PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELJHOTEL 13 PUMPER TRUCKIYARDICHEM TOILET:) <br /> ❑ TATTOOIBOPY PEIRCING 13 POOLISPA 0 U%NEI usr-APPLICATION srrr.s <br /> E3 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPEClFy)_ <br /> 1 List up to ten'addreSeSS in the space above. Select the type(s)of files fromthe list above by checking <br /> the appropriate box(es). At least one file type MUST be selected, Fax to 1*209)464-0138 or mail to til-61 <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confinlied <br /> approximately five business days but no later than ten (10)days after r000lpt Of application. The files, <br /> will be hold 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 immedhitelyovailobla 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$89.00 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 clay. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> BASE OONFIRMED PHONE FAX -IN1,11ALS <br /> YES NO REVIEW DATE <br /> EMU 48-02-006 <br /> W26IMS <br />