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04/28/2004 14:53 2094671118 AGE STOCKTON PAGE 01/0 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> APR 2 8 2004 ENVMONI MNTAL HEALTH D]EPARTM[ENT <br /> 1 Ij 304 E Weber Ave 3`d Floor Stockton, CA 95205 -7 <br /> U9)468-3420 Fax: (209)464.0138 Web:www.co,san-joaquin.ca,us/ch I <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: %GMENCY <br /> ADDRESS: 232 Li <br /> PHONE: aA. YyILQ1 FACSIMILE; Oy O <br /> TENTATIVE'APPOINTMENT DATE:- UCS /I/Q�fln:n7/I,7A•'o-�F.J(L/OTDYJfH <br /> UI <br /> Time: AFM <br /> (Please allow to buslnm days from data of appliaauoo sub . . <br /> 17 <br /> CHECK BOX TO EXPEDITE REQUE 3 00 FEE-REQUES P OC98SJEppD IN,�3,,ByyUSINESS9 9 <br /> SIGNATURE OF APPLICANT (eGLE1. DATE Y <br /> Departm nt Use Only <br /> FILE ADDRESS UNIT <br /> i. sere« tt" 0 U Sr li'J ❑ <br /> z s u S Unit 1 <br /> a. svan Ir �r cn f/ UST- <br /> 'Dy <br /> ❑ Unit2 y 3� <br /> a. 8v91 Q 0 I! /��� <br /> s sM1ea1 I Unit C <br /> r' V11 Z� <br /> 9. Slreal <br /> 7. stmat I Ualujiul 1 Unit4 <br /> A. $Fmm d <br /> P. SVee p <br /> ElUnit 5 <br /> tP. 'sneer el <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILI • <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE C <br /> UNDERGROUND TANK(MONITORING[REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOA30DY PIERCING ❑ POOUSPA M LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFYI <br /> 1. List up to ten addresses In the space above. Select the type(s)of riles from the list above by Checking <br /> the appropriate box(es). At least one file type MUST be selected, Fax to(209)464-0136 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 file Is available. <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. <br /> *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE:.. • "'. <br /> T.IM�.:. .. . <br /> DATE CONFIRMEB. ..i :PHONE::. r •TA3C' <br /> .. .. , <br /> REVIEWED.,:- YES :'. . NO <br /> EH9AaV1-0a5 - ' <br /> ueraaq <br />