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_----4)3/24/2004 10:35 F -AT 209 94806?11 <br />��',ATi=;;R�CEIVED <br />SAN JQAQtnN COUNTY - <br />V ENVIRONT4ENTAL HEALTH DEPARTMENT <br />MAR 2 4 2004 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br />tNVIR0NPf ti'J1 HEH(209) 468-3420 Fax: (209) 464-0138 Web: VrWW.co.sarl-joaquiMca-us/ehd <br />Ih <br />PERN11-F/SERVICES PUBLIC RECORDS RELEASE APPLYCAUON <br />APPLICANT:�i�iL_S <br />_X 6140 A/ <br />FILE ADDRESS <br />BUSINESS/AGENCY; <br />ADDRESS: <br />c19, -2r <br />2. S1 --'A • <br />J4o,-k&j <br />0002/002 <br />PHONE: a —9VT- 3f/ 5- FACSIMILE: <br />TENTATIVE' APPOINTMENT DATE; <br />A <br />(Pleaso allow 10 business days from date of application submittal) <br />CHECK BOX TO EXPEDITE REQUEST - S93A0 FEE - REQUEST PROCESSED IN 3 BUSNESS DAYS <br />SIGNATURE OF APPLICANT DATE 3 <br />Depactrnen Use Orty <br />ENVIRONMENTAL HEALTH DEPARTMENT FINS <br />UNIT <br />[] Unit 1 <br />2 <br />Unit 3 <br />Unit 4 <br />❑ Unit S <br />''4 <br />V <br />M °! <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING A13ATEMr-NT <br />FILE ADDRESS <br />�] OTHER CLEANUP SrrE (NON -LOP) <br />❑ FOOO FACILITY <br />V 'eI ol/ <br />2. S1 --'A • <br />/So ! <br />U atf� �. G 'f o <br />9. svt&i <br />❑ CHICKEN RANCH <br />cltf- <br />.�l _ <br />❑ MOTEMOTEL <br />e 16�11- NbT AV Pd ACir <br />S. Zif-31 <br />93S <br />LAND USE APPLICATION 5lTES <br />6, sv"' <br />❑ OTHER (PLEASE SPECIFIC <br />7. Street <br />CAY nn nn <br />6. SU-e1Cky <br />9. SUEa.,( <br />Ci <br />C*y 20 <br />ENVIRONMENTAL HEALTH DEPARTMENT FINS <br />UNIT <br />[] Unit 1 <br />2 <br />Unit 3 <br />Unit 4 <br />❑ Unit S <br />''4 <br />V <br />M °! <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING A13ATEMr-NT <br />t4SOLta WASTE FACXM � <br />�] OTHER CLEANUP SrrE (NON -LOP) <br />❑ FOOO FACILITY <br />❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONrTORING1REMOVAL.) <br />❑ DOG KENNEL <br />X1 DAIRY <br />HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />M PKG TREATMENT PLANT <br />❑ TIERED PERMrI•TED FACILITY <br />❑ MOTEMOTEL <br />Cl PUMPER TRuc"ARDfcHEM TOILETS <br />❑ TATTOO/BODY PIERCING <br />0 POOLISPA <br />LAND USE APPLICATION 5lTES <br />❑ MPD(CAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFIC <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(e-s). 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 EHD 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 new <br />application may be submitted when the rile is available. <br />4. Any file not returned In the same condition as released will be reorganized by END staff at the expense <br />of the applicant. Future file reviews by the same applicant may require a $93.00 de osit pngr to ev w. <br />5. "'TENTATIVE appointment dates must be confirmed with EHD staff.Own <br />G;� <br />6. Applications received after 3:00 pm will be processed the next business days <br />'.CON LRMED,APPOINTMENTDATE TIME '.Y.. <br />DATE-CONFIR ED <br />M `.PHONE FAX i� '��NTf.IAL•'S ra <br />RLl/fE1NED YES NO REVIEW DATE <br />EHO 4"2006 <br />AIM000 <br />