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Z002 06/14/2004 16:13 FAX 209 948062 DATE RELIVED SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 E Weber Ave 3d Floor Stockton, CA 95205 JUNJUN 14 201409)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us1chd ENVIRONMENT HEALTH nn PUBLIC RECORDS RELEASE APPPLLICA,T{I^ON APPLICANT: Atv 60r,IV BUSWESSIAGENCY: ADDRESS: ag s PHONE: 0 .3 FACSIMILE: TENTATIVE'APPOINTMENT DATE: G /?�0-5 nme: ba (Pkase allow 10 business days from date of application submida0 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE DepaM=t Use Only �7{" 2 FILE ADDRESS UNIT i see lUnit 1 a4:7--5 /ft// 5 ir✓ s�e o s� ctauCRY .. 2 D E 111,t,e sire LO •'� ✓ s. su<a 00 1/icfpJ - Unit �✓ ✓ s. sine /.2 E ue L-D a r/ Unit 4 ✓ ✓ 6. SOee O p.V CWI r. sr<e (00 G Lq ❑ Unit 5 io. see a ENVIRONMENTAL HEALTH DEPARTMENT FILES I UNDERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENT 1'SOLID WASTE F � ' wa jg.OTHER CLEANUP SITE(NON{OP) ❑ FOOD FACILITY JCSODD WASTE VEHICLE UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCK/YARDfCHEM TOILETS ❑ TATTOOIBODY PIERCING ❑ POOL(SPA ❑ LAND USE APPLICATION SITES ❑ 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 aboye by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0136 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 EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. S. `TENTATIVE appointment dates must be confinned with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. .CON ftRI&D.AP061,lTMENTDATE: %:: - .:,TIME `DATE:CONFIRMED •'i'PHONE FAX r"ANITIALS VdEV1EWED YES NO REVIEW DATE EMO�8-Y1L06 i:a - NO200)