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--DA'F-z REZVED <br /> SAN J OAQ UIN Co Lj.NT� ti-ftJ LQL:; <br /> I. L <br /> 6- <br /> EN 1RONMENUL HEALTIi Jjl�EPARTMENT <br /> 304EWeber Ave 3rd Floor Stockton, CA 95205 <br /> NOV 14 2003 (209)0&3420 Fax-, 09) 464-0138 Web; www.G0.Sa11-1l0aqU11Ua.dd1d <br /> 1, <br /> -F HEALTH PUBLIC RECORDS RELEASE'lAPPLICATION <br /> .")E <br /> APPLICANT: 0 J RMNESSIAGENCY: C <br /> ADDRESS; 9'4k7 <br /> LYY <br /> 29 <br /> PHONE: _y —FACSIMILE: li <br /> TENTATIVE"APPOINTMENT DATE, i Time: <br /> (Please al]Qw 10 buslnfjss days from date Of aPPlIcatlon submittal) <br /> CHPCK BOX TO EXPEDITE REQUEST-$93,00 FEF--REQUES <br /> PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT it DATE <br /> II 0Q"rtnr-n1 Use Only <br /> FILE ADDRESS I I IT <br /> 4�IAA AS E <br /> unit I <br /> 3, Preel ce F=- yle city <br /> 41Unit 2 <br /> 5, Slectl &d 2 Ac., 'A'/W C11 <br /> a. Unit (I-- <br /> J <br /> aly <br /> -2 <br /> Unit 5 <br /> L-M.- ZL f-47- cn <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> -?DERGROUND TANK(UST)CLEANUP SITE(LOP) h'-H'1UUSING ASATEmENT ix 0 SOLID WASTE FACIIJITY <br /> Vtv�hTHER CLEANUP SITE;NON-LOP) WFOOD FACILITY 13 SOLID WASTE VEHICLE <br /> ERGROUND TANK(MONITORIN GIRE M OVAL) 0 DOG KENNEL 0 DAIRY <br /> ozi, <br /> IIAZARDOUS wAs'm GENERATOR 0 CHICKEN RANCH 0 <br /> PK TREATMENT PLANT <br /> rTIERED PERMITTED FACILITY 0 MOTELIHQTEL 0 MPERTRUCKrYARDICHEM TOILETS <br /> 0 TATTOOIBODY PIERCING 0 POOUSPA Ij. �LAND USE APPLICATION SITES <br /> C1 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> I. List up to ton addresses in the Space above, Select the type(s) o:f' files from the list abo-ye by checking <br /> the appropriate box(es). At least one filo type MUST be selected.) Fax to f209)464-0138 or mail to the <br /> address indicated above. 11 <br /> 2. r:HD i 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 (40) 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. it <br /> 3. A file that is actively being worked on by EHO staff may not be immediately available for review. A new <br /> application may be submitted when the file is-available. 1F <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 appllcant�rnay require a$93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3,00 pm will be Processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIAL$ <br /> REVIEWED YES No REVIEW DATE <br /> -ND 40-0240L <br />