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UC;T 21 2004 11:40 FR TO 12094640136 P.01i01 <br /> .�' '„ «u» 11.44 41D4t:1 ENVIRONMENTAL H10 PAGE 01 <br /> DATE RECEIVED EHO LOG NUMBER <br /> SAN JOAQMN COUNTY <br /> EmRONMENTAL HEALTH DFPART)V1 N T <br /> 304 E Weber Ave 3`4 Ploor Stockton,CA 95205 <br /> OCA 2 1 200209)468-3420 Fax: (209)464-0138 Web:www.co.san joaquin.ca.uVchd <br /> ������,.ca°•�tNln�ht1,1 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESSiAGENCY. I-”. 5• � . <br /> ADDRESS: .703 Ti�32.�.-,^ Sui �) <br /> PHON . 376 -rf3 G �Acslatu,=: S o `f3'4 --7 6 . <br /> TE ATIVE•APPOINTMENT DATE. <br /> C/ <br /> (P{easo allow 10 busl/xaa days from data of appRca9or<eubmdla) - <br /> CHECK BOX TO EXPEDITE REQUEST•593,00 —REQUEST P SED IN 3 BUSINESS DAYS <br /> SIGNATURE Of APPLICANT 1 DATE G a <br /> Dewr4nent Use Orly <br /> FILE ADDRESS UNIT <br /> + �V C k <br /> sxew N I1,04W <br /> ❑ Unit t <br /> `rs i seen goo 5 r2C � AA1e r- 17 ss <br /> 2l1ILS sv�+ 3 { V o an C r o F - ❑ UnR2 <br /> 6, aa.al a Unit 3 <br /> CRY <br /> e. s <br /> 7. <br /> Jilmy Unit4 <br /> U 5 _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUNO TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT O Bout) ;I`A <br /> }OTHER CLEANUP SITE(NON-LOP) O F000 FACILITY O soup WAS)i'E VEHICLE <br /> 7�UNDERGROUND TANK(610NITORINOREMOVAL) 0 DOG KENNEL O DAIRY <br /> • FIATAITDOUS WA4TE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY C3MOTELIHOTEL O PUMPER TRUCK!'rARD7cHEM TOILETS <br /> • TATTOWBOOY PIERCING O POOLFSPA tl LAND USE APPLICATION SITES <br /> • MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate box(es). At Jowl one file type MUST be selected. Fax to 1209)464-0138 or mall 11011"19 <br /> address Indicated above. <br /> 2. EHD will notify the applicant If any EHD files exist An appointment for review Vrill 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 avallable 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 some 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 9:00 pm will he processed the next business day. <br /> C•ONFII2MED ApP01NfMENT PATE TIME r' <br /> DATE CONFIRMED aPHONE FAX aN1T)ALS <br /> 'REVIEWED i YES NO REVIEWDATE• <br /> GCT 21 2004 11:21 _.. <br /> ** TOTAL PAGE.01 ** <br />