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66/22/2064 11:59 30376" " 9 TECHLAW INC PAGE 03/0 <br /> 0 <br /> EHO LOG NUMBER <br /> ID) [� 1C1 SAN JOAQUINi COIN Y <br /> !6nS 7k0j rte' <br /> CD 1 I E,VWONWNTAL 11EA,LTH DFPA.RTMENT <br /> U 2 2 nn 304 E Weber Ave 3'd ploor Stockton,CA 95205 <br /> 969) 468-3420 Fax.: (�09)464-0138 Web: WWW.co.san-joaquin.ca.usfehd <br /> EWRUN EN'i HEALI i PUBLIC RECORDS RELEASE APPLICATION <br /> ,�y,,n, �y f BuSINESSIAGENCY: Y� <br /> APPLICANT: <br /> �2100-—Laujd�— <br /> �4 <br /> ADDRESS: II <br /> PHflNI :�! v3�j f l,.~Z FAGSIMIL'E' <br /> TENTATIVE"APPOINTMENT DATE: - ka Tyne: <br /> (PleaSa allow 10 bugirass days from date of applTcatien submittal) <br /> ❑ CHECK BOX TO EXOEDM REQUEST-$93.00 FEV--REoUEST PRoc5SSED IN a BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT Deoartmei� Use Only <br /> UNIT <br /> FILE ADDRESS <br /> p Unit 1 <br /> s, sued '1`'4 <br /> z, sow ea 44e'l hit 2 •.)U t <br /> r' Vv <br /> Street <br /> GI <br /> s. street nit 4 <br /> CVF p Units <br /> stmt <br /> LO <br /> ty <br /> y. G <br /> 10- S9nM 7 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> i' <br /> Ct EANUP SITE{Lal'i O HOUSING ABATEMENT ", SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST} ❑ FOOD FACILITY Ifl SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 17 DAIRY <br /> UNDERGROUND TANK(MONITORIN(WREMOVAL) 13 DOG KENNEL la pKG TRF!ATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PUMPER TRUCKIYARD/CHF_M TOILETS <br /> ❑ TIERED PERMITT1=d FACILITT ❑ MOTELIHOTEL Cl LAND USE APPLICATION SITES <br /> PA <br /> C3 TATTOOMODY PIF-tC'NG 0 OTHER(P <br /> ❑ MEDICAL WASTE Fr4CWTY ❑ OTHER(PLEASE SPECIFY} <br /> 7_ List up td ten addresses In the space above, Select the types)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 /> addI,ess indicated above, appointment for review will be confirmed <br /> 2. EHD will notify the applicant a any EHD files exist. An apps s after receipt of will <br /> be on fir The files <br /> approximately five business days but no later than ten (10)day <br /> will be held fora maximum of five business days for review. Appointments should be scheduled <br /> acro ngly. y not t>s Immediately available for review. A new <br /> 3. A file at is active! 'being wOwhe t e EHD staff may <br /> application may be submitted when the file is available, <br /> 4. Any fil,�not returned in the same condition as releasedIlcalntlrna be reorganizedire a$93.0 deposit prior to rev sw. <br /> of the applicant. Future file reviews by tate same app Y <br /> 3, "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Appl"tlons 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 /> eHn 48-ox-om <br /> ererxws <br />