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05/2012004 12:53 3037;?,9889 TECHLAW INC PAGE 0210 <br /> DATE RECEIVED E��Loi NU <br /> AN JOAQ IN COUNTY <br /> r� M44M <br /> EN ENTA � A LTH DEPARTMENT <br /> T <br /> 304 E Weber Ave 3 Floor Stockton,CA.95205 <br /> AY 46 -3420 Fax: (209)464-0338 Wel : www.co.san joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECOPDS RELEASE APPLICATION <br /> TION <br /> Kmt <br /> APPLICANT: 0 �tJ1nae/ BUSIidESSIAGENCY: Tom __2\4 <br /> ADDRESS:'-. � <br /> 10 5 t?--g t,171 A S-€'_ o C"0 ,V01 <br /> PHONE: 41 ld 531 FACSIMILE: Q 1>) 2a— <br /> TEi+ITATiVE*APPOINTMENT DATE:_ � � �Time: 1�' V� a kA <br /> {Please allow 10 business da s from date o application submittal) ri <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS A-my ;?—o ro e.Y-0 <br /> SIGNATURE OF APi'LICANT ( DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. Street kmo2ry AiirhCft ® Unit i r � <br /> Z $treat <br /> k Street Unit �r <br /> s. Unit 3 <br /> 9. $treatCRY <br /> r, street c <br /> fe En:R4: <br /> �. street <br /> CKy <br /> s. suset � <br /> ❑ Unit 5 <br /> itt. street 0 <br /> e- _ <br /> ENVIRONMENTAL HEALTH 13EPARTMENT FILES ' �g�g <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ` SOLID WAS FAGIt-('i'f <br /> OTHER CLEANUP SiTE(NON-LOP) 0 FOOD FACILITY 0 $01,i0 WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGmEmovAL) a DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELiHoTEL 0 PUMPER TRUCKlYAROICHEM TOILETS <br /> ID TATTOOIBODY PIERCING C3 POOL*`SPA 0 LAND USE APPLICATiON SITES <br /> 0 MEDICAL WASTE.FACILITY 0 OTHER(PLEASE SPECIFY) <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(2091404-0138 or mail to the <br /> address indicated Above. <br /> 2. END will notify the applicant if any END files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10)days after receipt of appiication. The files <br /> Will be held for a maximum of five business clays for review. Appointrrlents should be scheduled <br /> accordingly. <br /> 3. A file that is actively being Worked on by END 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 END staff at the expense <br /> of the applicant. future file reviews by the.salve applicant may require a$193.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6, Applications received after 3:00 pm Will be processed the next busin <br /> CONFIRMED APPOINTMENT DATE TIME <br /> 4 : <br /> DATE CONFIRMED <br /> PHONE PAX INITIALS <br /> REVIEWED YES 140 R EW DATr4 <br /> Fwa ae.aa.tra� <br /> i <br />:i <br />