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.004 16:12 FAX 209 9480 0002 <br /> c RECENED cnv,............,.�„ <br /> SAN JOAQUIN COUNTY <br /> ENviRoNmENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'd Floor Stockton, CA 95205 r` <br /> (209) 468-3420 Fax: (209)464-0138 Web:www.co.sanjoaquimmus/ehd X <br /> OCT 2 1 2004 ((JJ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> t'Fas�LJi7NlF�' �ro3'h BUSINESSIAGENCY: 1�141M- deJ _ <br /> ADDREss: �Ra� Gti1� _ tet Lzk1w. <br /> PHONE: t3�1! �T47'i ''). � FACSIMILE: _Q�p9� 9gy— pr -7,1 ,\ <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Plsasa allow 10 business days trom date of application submtun <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEEE-REQUEST PROCESSED IN 3 BUSINESS DAYS O <br /> SIGNATURE OF APPLICANT ,�'� DATE <br /> Department Use Only ,; <br /> FILE ADDRESS UNIT , V <br /> r� <br /> 1. snrd 00 T�. Unit 1 <br /> 2. sued Cl -U�a h Vt \. <br /> 4. swag Urn 2 N�,.\ <br /> i. $eee U <br /> 6, 54ct <br /> T. sued <br /> Unit 4 <br /> ❑ nit 5 <br /> to. saes G ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT IRL SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) In FOOD FACILITY ❑ SOLro WASTE VEHICLE <br /> �- UNDERGROUND TANK(1410NITORINOIREMOVA14 ❑ DOG KENNEL B-DAIRY <br /> i0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH IRL PKG TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY ❑ MOTELMOTE , ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOMOOY PIERCING ❑ POOL/SPA A& LAND USE APPLICATION SITES <br /> El 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 aboye by checking <br /> the appropriate hox(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 END staff may not be immediately available for review. A nev <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 reviev <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 /> sCONB(f�MED.:4pRO1NTNIENT'DPTEr TIMEC*F ':. .:u <br /> 'DATE CQNFIRINED ;^ - ".k.; ,': ^ 1ni`%' .:;: ;•. -,- <br /> :"PHONE. : FAX ' ''x,..G1NF(4.S <br /> REVIEWED YES NO REVIEW DATE' ' : - <br /> ' FHp ra.yz�ai <br /> ua2vo� <br />