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JUN -1'(-200b 16:19 r-nNDOR EARTH TECH 209 532 0773 P.02 <br />OAIN J VAV L)IA %,U UiN JL X <br />HEMWEIDJ EkoNmNTAL HEALTaDF-)PA*RATENT <br />304 E Weber Ave 3rd Floor Stockton, C.A. 95205 <br />`;;r' ?099) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd <br />iNVIRONMENT HEALTH PUIBLIC RECORDS RELEASE APPLICAMN <br />APPLICANT: 1" A-rS(4 t A BUSINESSIAGENCr. 04 94 r /A, r - <br />ADDRESS: <br />PHONE: 2:Q2 . FACSIMILE; <br />TENTATIVE* APPOINTMENT DATE: I 0vL,-LI -a2o65-, Time: LA <br />0 <br />(Please allow to buslrw= days from A of appilcatlon submittal) <br />1:1 CHECK BOX TO EXPEDITE REQUEST -$93.00 FEE - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE <br />I/ <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />De"ftent Use On1v <br />UNIT <br />Q Unit 1 <br />Unit 2 , 1� <br />OF <br />Unit 3 <br />Unit 4 <br />1K UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />El HOUSING ABATEMENT <br />11 Ver - <br />FILE ADDRESS <br />0 FOOD FACILITY <br />2. <br />sued <br />1 7 3 <br />0 PKG TREATMENT PLANT <br />d4f <br />3. <br />Wcck <br />at 0 <br />0 POOLISPA <br />F: -LAND USE APPLICATION SITES <br />4. <br />SOL -,q <br />I- <br />_sveel <br />q-f;l S. <br />Oty <br />3"M <br />IV <br />sued <br />% 10 5C -a <br />-CA 0— <br />L7, <br />Sind <br />10. <br />sued <br />944 5., �5—toek-f-or% <br />8Y2, <br />at <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />De"ftent Use On1v <br />UNIT <br />Q Unit 1 <br />Unit 2 , 1� <br />OF <br />Unit 3 <br />Unit 4 <br />1K UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />El HOUSING ABATEMENT <br />SOLID WASTE FACILITY <br />IV <br />OTHER CLEANUP SITE (NON -LOP) <br />0 FOOD FACILITY <br />SOLID WASTE VE141CLE <br />9d DAIRY <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />11 DOG KENNEL <br />0 CHICKEN RANCH <br />0 PKG TREATMENT PLANT <br />HAZARDOUS WASTE GENERATOR <br />L,3 TIERED, Pimni'ED FACILITY <br />13 MOTELJHOTEL <br />13 PUMPER TRUCKrYARDICHFM TOILETS <br />to TATTOO(BODY PIERCING <br />0 POOLISPA <br />F: -LAND USE APPLICATION SITES <br />Ar MEDICAL WASTE FACiLny <br />C3 OTHER (PLEASE SPECIFY) <br />1. List up to ton addresses in the spare above. Select the type(s) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0`138 or mail to the <br />address lndlc.;atedabove. <br />2. F -HO 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 ton (10) days after receipt 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 immediately avallable 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 />ofthe applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to-revisw <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 />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS'- <br />REVIEWED ­ YES NO REVIEW DAT I f <br />EM U42-4006 <br />WW2033 <br />TOTAL P.02 <br />