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TDA'i E RECEIVED SAN JOAQUIN COUNTY ;,,;' ' N ,'IRONMk;NTAL UEALTH DEPARTNIENT 304 E Weber Ave 3 Floor Stockton, CA 95205 UV 1 4 2003 (209) 468-3420 Fax-, (209) 464-0136 Web; WWW,C0.5aI1-j0aquin.Ca.dChd NViRUNMEN i HEALTH PUBLIC RECORDS RELEASE APPLICATION APPLICANT: _.I Ll, in T= 1. lrt k✓ ->z+ I BUSINESSIAGENCY: o -MU u.ne rvumir.cr 1568 ADD- &��s AXAV>.a►alrwi�® f �Irwf�Y./ii111►Tra�► PHONE:sr FAOSIMI TENTATIVE APPOINTMENT DATE: Time: (Please allow 10 business days from date of application submittal) © CHECK BOX TO EXPEDITE REQUEST- $9300 FEE -RE4UES PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE; U/2 _f / ENVIRONMENTAL HEALTH DEPARTMENT FILES K ns�_aldl 1,10V a2003 h/ )m Department Use Only Z �Uhit . ✓ Unit Unit 4 [� I roil G yNDERGROUND TANK (UST) CLEANUP SITE (LOP) HOUSING ABATEMENT ❑ SOLID WASTE FACILITY - i VHER CLEANUP SITE (NON -LOP) WFOOD FACILITY O SOLID WASTE VEHICLE ERGROUND TANK (MONITORING/REMOVAL) ❑ COG KENNEL 0 DAIRY � TIERED WASTE GENERATOR ❑ CHICKEN RANCH ❑ PK TREATMENT PLANT TIERED PERMITTED FACILITY t7 MOTEL/HOTEL EXLIMPERTRUCKIYARDICHIEM TOILETS ❑ TATTOOIBoOY PIERCING O POOUSPq LAND USE APPLICATION SITES In MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209'1464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. 5. `TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE dIV2003 FILE ADDRESS 1. Steel a. Siroel t. C. r �. Slree! U f r Slrce� �f1f �(1! 4. �✓�✓ C'v A B. S': 'S�--r/� 0i ]. Sveer i-. L /a ) V OI / ENVIRONMENTAL HEALTH DEPARTMENT FILES K ns�_aldl 1,10V a2003 h/ )m Department Use Only Z �Uhit . ✓ Unit Unit 4 [� I roil G yNDERGROUND TANK (UST) CLEANUP SITE (LOP) HOUSING ABATEMENT ❑ SOLID WASTE FACILITY - i VHER CLEANUP SITE (NON -LOP) WFOOD FACILITY O SOLID WASTE VEHICLE ERGROUND TANK (MONITORING/REMOVAL) ❑ COG KENNEL 0 DAIRY � TIERED WASTE GENERATOR ❑ CHICKEN RANCH ❑ PK TREATMENT PLANT TIERED PERMITTED FACILITY t7 MOTEL/HOTEL EXLIMPERTRUCKIYARDICHIEM TOILETS ❑ TATTOOIBoOY PIERCING O POOUSPq LAND USE APPLICATION SITES In MEDICAL WASTE FACILITY ❑ OTHER (PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209'1464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review. 5. `TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE dIV2003