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11/01/2004 12:10 FAX 209 94D^q21 002/002 <br /> CIIV IVV 1\4. +ti1 <br /> �u>=D SAN J•OAQUIN COUNTY <br /> IJP] _11 u UENVIRONN ENTAL REALTH DEpAR IYNT <br /> NOV - 1 2004 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> 4 <br /> (209) 468-3420 Fax: (209)464-0139 Web'. ww,co.san joaquia ca.&ehd ���/// <br /> w <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS PELEASE APPLICATION <br /> APPLICANT: �`l-t —��( �l✓� BUSINESS/AGENCY: /JIP iC1� <br /> ADDRESS: 67A (avf Lb, CA <br /> PHONE: at!�( FACSIMILE: a i �•X - D62-1 <br /> TENTATIVE'APPOINTMENT DATE: dro& ( Time: <br /> (Please allow 10 business dayS from date of application submittal) <br /> Q CHECK BOX TO EXPEDITE REQUEST 49 .00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �-- DATE <br /> Deoartment Use Only <br /> FILE ADDRESS UNfr <br /> r <br /> L4, City <br /> Lk t5ri Ct,4 ❑.• -Ur1it 1 <br /> z Sty <br /> 1 o r ' <br /> Unit 2 <br /> a strou 1 G of-t`'h7 \ lil <br /> tz�4. Sueel e Qr G 5k4L' �. ..L �, <br /> 6 saw a Unit 3 <br /> 6. S1tCe1 <br /> Unit 4 <br /> CRY <br /> 9 s G Unit 5 <br /> 14_ Sb­1 C' <br /> c <br /> ENVIRONMENTAL.HEAJ_TH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT K SODU WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> ®- UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL IE DAIRY <br /> Z HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 9--PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARAICHEMTOILETS <br /> Q TATTOOlBODY PIERCING CI POOLtSPA lA LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(1PLFA5E SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)or files from the list aboye 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. <br /> 2. EHD will notify the applicant if any EHO files exist_ 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 EHD staff may not be immediately available for review. A Herr <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 reviey, <br /> 5, *TENTA7NE appointment dates must be confirmed with EHO staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONE_IRM�D.APPOIiITMENTDATE '.r <br /> ,TIME <br /> r.'., <br /> ''PHONE FAX'" <br /> 'DATE CONFIRMED - <br /> REVIEWED YES 'NO REVIEW DATE, <br /> EHD IE-02-0a6 <br /> . 6fDl200] <br />