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Apr. 26. 2005 2: 06PM AD 'ED GEO No. 0333 P. 1 <br /> DATE RECEIVED ._ SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT ' �Iq <br /> 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ebLd 1005 APR 26 P <br /> 33 <br /> PIC RECORDS RELEASE APPLICATION/� PH '3t <br /> APPLICANT: - <br /> � 7 11 ynVSINESSIAGENCY: OdUdnt i?d Q0& !� f Y QNLTY <br /> ADDRESS: �7U./ d SlfJC l:l/7� Sd/1�`S` flerdr <br /> PHONE: 84)9' y� /`�Q�� FACSIMILE: ,o <br /> d: �prnUJ <br /> TENTATIVE*APPOINTMENT DATE: O Tlme: � O!�� <br /> (Please allow 10 business days from date of application „ <br /> CHECK BOX TO EXPEDITE REQ ST- 97.00 FEE-RE T PRO ES$ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7 <br /> Departmert Use Orly <br /> UST NT.J <br /> FILE ADDRESS UNIT <br /> 5oee <br /> 2. secs 10// <br /> / C SL <br /> q ?X <br /> ❑ Unit 1 <br /> s. Sven q O <br /> 2 <br /> ,. even �1 <br /> a. srex J <br /> 7. 6treaf <br /> a svea nit 4 <br /> 2. even <br /> ❑ Unit 5 <br /> t0, vest <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST(CLEANUP SITE(LOP( ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACI <br /> OTHER CLEANUP SITE(NON-LOPI 13 FOOD FACILITY O SOLID WASTE VEH <br /> ?Usk <br /> UNDERGROUND TANK(MONITORINGIREMOwLL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR t] CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKMARDICHEM TOILETS <br /> 13 TATTOOfBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 13 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(20914640138 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 now <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 /> CON FIRMEDAPPO(NTMENTDATE :TIME : <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 6lto,e.ozaac <br /> era3esa <br />