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\ ' OS/03/2004 10:24 2094671 AGE STOCKTON PAGE 01/11 <br /> V DATE RECE VED END LOG NUMBED <br /> Sa1v JoAQuzrr CourrrY <br /> ENVIRONMENTAL E We IE Ave HEALTH DE, AR95205 T <br /> ITl] ll L� 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> JUN Q 3 2flV)468-3420 Fax: (209) 464-01.38 Web: ww-w.co.san-joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ARP4K'S'.4NT.`S ('�UjIZ/} .-t06ma �&Fj—lt&USINESSIAA //r�GEENCY: , 41CA 60 IM1jginl ��.-�ADDRESS: SJ ! W �1`-e� • <br /> PHONE: -- FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: /VPS JUY142 9 T.: . y, <br /> (Please allow 10 business days from date of application submittan -[.T V � 0mo �e Y(L 2. <br /> `�/J J�an y are read y../. . <br /> x CHECK BOX TO EXPEDITE REQUES -f9 .00 FEE-REDDEST ROC ED IN 0 BUSINESS DAYS' <br /> SIGNATURE OF APPLICANT /LI/lt fJ Q DATE �y <br /> '�I���rr"1� artmemuseONv <br /> FILE ADDRESS UNIT <br /> 1met L <br /> t. 9 ��t>w� — <br /> [] Unit 1 <br /> '��` z► sly /' C�n ; c� i7.Cn� <br /> 2 <br /> Unit r [ <br /> d. street Q X51 ctcnv `J <br /> s street I $ C / U_ nit 3 <br /> 6. Swot <br /> CI u5 �;,. , <br /> r, seen E • it DIV nit 4 <br /> B SrtMx .�3'7��' • _ <br /> a. swet yy-�'-- unit <br /> ,a. sem o? — A u7'r c <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> r lfw �9 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACWTY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK ORING/RFJIAOVAL) ❑ DOG KENNEL C3DAIRY <br /> HAZARDOUS WASTE GENERAENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> nERE0 PERMITTED FACILITY ❑ MOTELIHOTEL O PUMPER TRUCKrYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA LAND USE APPLICATION SITES <br /> ❑ 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 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 /> 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 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 same applicant may require a$93.00 deposit prior to review. <br /> 6. "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 /> e <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> END <br />