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DEC-01-03 12:38 _ FROM-COLDER ASSOC +949-583-2770 T-344 P.01/01 F-889 - <br /> DATE R D_ �/ EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> ��`,,1 'f I,JI 1 L ENVIRONMENTAL HEALTH DEPARTMENT <br /> DEC C �( pp X�1122 304 E Weber Ave 3`d Floor Stockton, CA 95203 1 G q0000 <br /> (209P48-3420 Fax: (209)464-0138 Web: www.co.Sanj <br /> oaquin.ca.us/chd 1 J\ <br /> ENViRON(VIEN'I HEiiL11 <br /> PFRMiSERVICFCQ(�UBLIC RECORDS RELEASE APPLICATION <br /> K _ <br /> APPLICANT: rtS n L7(OSer BUSINESS/AGENCY: Go�cj6r RS'$0d4t&4 -a, r , <br /> ADDRESS: StL IS =VJl n.¢ , CA 112-6 15f <br /> C1411- <br /> PHONE: _ILIA^S83T-2.-IOO FACSIMILE:_ 6 <br /> TENTATIVE'APPOINTMENT DATE: Ptec,%e Co-11 <br /> (Please allow 10 business days from date of application submittal) DEC — I 2nr: <br /> 13 CHECK BOX TO EXPEDITE REQUESTY-P,&00�FEE-REQASSST�PRO�CESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /\.i/ii/ � /,/iGa'J-�- DATE 12 D 3 <br /> Depamnent Use Only <br /> 4 FILE ADDRESS MI_ UNIT <br /> I. weal v 'C ca n C0. f ❑ Unit '71 <br /> z 5lreet n r or AGIVgn CII V <br /> 0. syeN C ohne t BS cl h� <br /> ll [I U It Z <br /> e S... c ^J1,JJY' <br /> 1 I% <br /> 5 slr"t C6 <br /> Uni <br /> 6 s:ree: CO <br /> l street Cit <br /> 9. svaetD I�Unit 4 <br /> C6 <br /> 9 5!reN C6 <br /> E] Unit S <br /> to 5neei <br /> Cn rr <br /> ENVIRONMENTAL HEALTH DEPARTME�FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SCUD WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> �( TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> L7 TATTOOIBODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ 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 (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 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. *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 TIME <br /> DATE CONFIRMED _ PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ENO 44-62-006 <br /> NN2003 <br />