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1v;28/2004 19:24 FAX 209 94808• z • Vfpj009V"` <br /> DATE RECyEIVED SAN,1 OAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3d Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:wanv.co.san joaquin.ca us/ehd <br /> 0000e) <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> S I�ir, Id�r <br /> ���;^� 4,n��)v BUSINESSlAGFlICY:� <br /> pDLxLEss:,^ a53d, - (•A'IJr}fie ` +'-e 47 lzfo„ <br /> PHONE: a�y5 FACSIMILE: 0�9N'd'CtzAa+ - <br /> TENTATIVE'APPOINTMENT DATE:III�6-1 TM: <br /> (Please allow 10 business days from date of application submittal) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS 7�, <br /> SIGNATURE OF APPLICANT YID �' r� DATE <br /> Department Use Oniv <br /> FILL:ADDRESS UNIT <br /> !Ill �. sorer rl 6l- PL1V•� My $n LI`I p Unit 1 <br /> NFL z Sr v G GSok¢t- 'Czv �n <br /> I-I 3. Bred (rte Ue(So.. afl z {on Unit 2 <br /> -- oak Unit 3 <br /> , I % 5, Sdcd <br /> Ad 11�-eZ <br /> - <br /> r" street � Unit4 <br /> 11. s°ret a <br /> Unk 5 <br /> 9" Sheer <br /> CRY <br /> 10, street <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 02L UNDERGROUND TANK NST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 49 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(MON-LOP) 13FOOD FACRRY ❑ SOLID WASTE VEHICLE <br /> 19 <br /> gO UNDERGROUND TANK(MONITORINCIREMOVAL) ❑ DO0 p <br /> C KENNEL UpKG <br /> ❑ CHICKEN RANCH VMTREATMENTPLANT <br /> 0HAZARDOUS WASTE GENERATOR � ❑ µ0•��0.� ❑ PUMPER TRUCKNpI2DiCFIEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOLBPA IA LAND USE APPLICATION SITES <br /> OI <br /> ❑ TATTOBODY PIERCING El OTHER(PLEASE SPECIFY) <br /> O MEDICAL WASTE FACMITY <br /> 1- List up to ten addresses In the space above. Select the type(s)of files from the list above¢y checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 b64A138 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 /> ll he held for a maximum of five business days for review. Appointments should be scheduled <br /> wi <br /> accordingly. <br /> 3. Afile 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 /> b. 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 /> 5. `TENTATIVE appointment dates must be confirmed with EHD staff• <br /> g. Applications received after 3:00 pm will be processed the next business day. <br /> - TIME <br /> ER -DI <br /> b YES !NO REVIEW DATE. ''t <br /> EFtn yna.oae <br /> erarzaat <br />