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tH0 LOU NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPAR��ENT I C2 <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> (209)468 3420 Fay: (209) 464-0138 Web: www.co.san-joaquin.ca.0 ,d <br /> 00 <br /> PUBLIC RECORDS RELEASES gAPPLICATION <br /> APPLICANT: _ BUSINESSIAGENCY: <br /> YY",VM r'� '�`�'d - — <br /> ,�.� u" <br /> ADDRESS: (, <br /> �' <br /> 7JU+`�.. -- ._.--FACSIMILE: � (0 G1 " 7.2- 6 <br /> PHONE: <br /> (0a _.Time: <br /> TENTATIVE'APPOINTMENT OATS: ' -... <br /> (Please allow 10 business days from date of application submittal) <br /> it CHECK BOX TO EXPEDITE REQUEST-$93.00 FE —REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> �q/�� DATE 3a <br /> SIGNATURE OF APPLICANT —S Depanmenl Use Only <br /> UNIT <br /> PILE ADDRESS <br /> :. succi 127-5 S Sn.waw.s�+.-IC'o Sk- MIXL°d+� Fn�l Unit 1 <br /> G & 5 <br /> ?. seei �] U <br /> Gli <br /> i. suvnit 2cci S ISI 0u • <br /> �. street �ct <br /> /Unit 3 <br /> s. srrhl <br /> �2 at <br /> o� <br /> e. F em <br /> cu d Unit 4 <br /> �` <br /> From <br /> Unit 5 <br /> g, SIMM i <br /> 10. slrcel <br /> ENVIRONMENTAL HEALTH DE TME9 FILES <br /> '¢l UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> '61. OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL ❑ DAIRY <br /> IS UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR In MOTEUHOTEL 17 PUMPER TRUCKIYARDICHEM TOILETS <br /> TIERED PERMITTED FACILITY ❑ POOLISPA O LAND USE APPLICATION SITES <br /> ❑ TATTOOIBOOY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1. List Up to ten addresses in the space 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 209 464.0138 or mail to the <br /> address indicated above. xist. An appointment for review will be confirmed <br /> 2. EHD will notify the appiipant if any EHD files e <br /> approximately five business days but no later than ten (10) days after <br /> receipt <br /> thou dof pbe lication. <br /> The <br /> files <br /> will be hold for a maximum of five business days for review. App e <br /> ed <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD 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 file reviews by the same applicant may require a $93.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be confirmed with EMD staff. <br /> 6. 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 DATE <br /> ------------ <br /> ewoes-oaao` _ I , p. ., J pQ ( •Q,pQ �'l� (Q��ol�.xcJ 51�07 <br /> �,VP .a- gnA„J 4-6 OM U <br />