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IJ f <br />` f - u EN` "`RONMENTAL HEALTH DEPARTMENT <br />E Weber Ave 3rd Floor Stockton, CA X35 <br />APR O �g�} 468-3420 Fax. (249} 464-0138 Web: www.co,San joaqum.ca.us/ehd <br />ENVIRANIEry-i HEALTH 1� <br />PER?vilT/SERVU,q PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: j G �, j e L BUSINESSIAGENCY: A <br />ADDRESS: 111-7 Lowe- PwJu, 4 Vt SveB /1-1oJeJo) C,} <br />PHONE: zoq- S-49-2221 FACSIMILE: -1J9" <br />TENTATIVE* APPOINTMENT DATE: <br />- Z225 <br />Time: <br />(Please allow 10 business days from date of application submittal} <br />I <br />CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE — REQUEST PROCESSED 1N.3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />S. <br />s. <br />DATE <br />- 6 -04 <br />Department Use 1 <br />3 <br />FILE ADDRESS If. UNIT <br />I <br />V9W? <br />i o✓f w+ <br />G <br />'21' a k o I <br />❑ Unit i <br />gso6 <br />S.J)�� o� <br />a <br />sfo�c�,�. <br />jil(2 <br />S. gi as W. <br />ca <br />5 o<<G i <br />Unit 2 q-, <br />6122- <br />SW <br />1 � <br />�oz0 <br />; W <br />a <br />'! <br />S(i�1,�k-6,'! <br />f� Unit 3 <br />2o00J{ <br />CSy. <br />1 COk da � <br />G <br />y, <br />.l"t' C <br />�5D3 <br />S . Qiryarfi hl•.- <br />CI <br />S f li�v4+ <br />it 4 <br />v. <br />ENVIRONMENTAL HEALTH DEP <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY <br />UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH <br />❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL <br />❑ TATTOOBODY PIERCING ❑ POOL/SPA <br />E FACILITY ❑ OTHER (PLEASE SPEC <br />❑ Unit 5 <br />ENT FILES fl, gmn1 <br />)(SOLID WASTE_FA. lC�TX t .. = <br />11 SOLID WASTE V1 Id <br />❑ DAIRY <br />❑ PKG TREATMENT PLANT <br />❑ PUMPER TRUCKIYARDICHEM TOILETS j <br />❑ LAND USE APPLICATION SITES 1! <br />❑ MEDICAL WAST <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above py 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 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. ii <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. 1�' <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 />5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 3:00 pm will be processed they next business da <br />CONFIRMED APPOINTMENT DATE!,TIME <br />DATE CONFIRMED. PHONE FAX' - INITIALS <br />h <br />REVIEWED - YES NO REVIEW DATE <br />EHO 48-02-006 _ <br />RM7003 - <br />