Laserfiche WebLink
12/03/2004 10:28 4640138 EWIRONMENTAL HEALTH PAGE 02 <br /> DATE RECEIVED � EHD LOG NUMBER <br /> J SAN JOA CO <br /> Ci`� <br /> ENVIRONMENTAL T)3(DFPARTmENT <br /> 304 E Weber Ave 34 Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138Web:Www.co.sm-joaqujn-ca-us/ehd <br /> PUBLIC RIECORDS RELEASEAPPLICATION <br /> APPLICANT: �'(� < �c� P BUStNESSI ENCY:, ACT clee 'yu t�K Vit' <br /> ADDRESS: <br /> PHONE: � Z e jx I t& <br /> c% <br /> FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Please allow 10 business days from date al'applic4on submtttai) <br /> ;kPHECK 13OX TO EXPEDITE RE9y9Sj 493.00 PEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ✓/ DATE Ct — <br /> t Use only <br /> FILE ADDRESS UNIT <br /> v V+.-NST'ST' 1. sura l-5 7 <br /> btvs, ❑ Unit 1 <br /> r 1 2. saeet 2 L;n <br /> 3. S�eR! L yi^V� ! \ [ <br /> _ (J r-_ t ) f <br /> e. &beet 72•- O C� ;C tl ® Unit 2 <br /> s. sCky _ Unit 3 <br /> 6. surer <br /> r' sv"4 CIMTM Unit 4 <br /> s. seeet ❑ Unit 5JA 10 MY <br /> fi <br /> 10. Strout 4` _ <br /> ENVIRONM ALM DARTMENT FILES <br /> r.,_ . <br /> OL UNDERGROUND TANK(UST)CLEANUP SiTE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY c <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACUff O SOLID WASTE VEHICLE <br /> 0-UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAiRY <br /> 1Q.HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELA40TEL O PUMPER TRUCKIYARDfCHEM MM 4;` <br /> ❑ TATTOOt80DY PIERCING C3 POOLISPA 0 LAND USE APPLICATION SITES <br /> O MEDICAL,WASTE FAClt= ❑ 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(2091464-0138 or mail to the <br /> address Indicated above. <br /> 2. EHD Will notify the applicant If any EHD files exitt. 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 EMD 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 fife reviews by the same applicant may require a$93A0 deposit prior to review. <br /> S. *TENTATIVE appointment dates must be Confirmed with EHD staff. <br /> S. Applications received after 3:00 pm will be processed the next business day. <br /> IiAENT PALE ;�'' TIME <br /> �COi�ti=ltE'D ►lt ¢lN1` �" <br /> :r.t:.«:i�r: z�c• <br /> "P ONE FAX iNil`IAI S -_ <br /> kitVIEWED r YES NO REVIEW PATE.. <br /> ' 1:?tD 48-OZ-0Q6 <br /> 8!8@903 <br />