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Z002 <br /> 06/14/2004 16:13 FAX 209 948062" <br /> F...,pbTERECEIVED SAN JOAQUINCOUNTY �. <br /> rD aI `l� ENviRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'd Floor Stockton,CA 95205 <br /> JUN 14 M409)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin-ca-us/elid. <br /> g <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLICANT: N BUSNESSIAGENCY: <br /> ADDRESS: ag S /", <br /> PHONE: 3 FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: /��/ 0 3 Time: <br /> (Please allow 10 business days from date of application submittaq <br /> CHECK BOX TO EXPEDITE REQUEST:$93.00 FEE-REQUEST PROCESSED IN 33 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /ZQ�Ll3�e ^ `—" DATE 611Y O " <br /> Depart ent Use Only <br /> ,7t 2 <br /> FILE ADDRESS - . UNIj❑ Unit <br /> z soca 5 Kt// 5 L <br /> / /✓ a so k »lav 60 0 PA stere Go <br /> /✓ / QA t/ YLf! "" ❑ <br /> 10. Street G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES PIR. <br /> AN �4 g <br /> �.UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT d SOLID WASTE FACILFPY�+ ' K3!;. "'" <br /> }4 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> }i�UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOC KENNEL ❑ DAIRY - <br /> ]5 HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY 0 MOTELMOTEL 0 PUMPER TRUCKAYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCMG ❑ POOLISPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 13 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 /> S. '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 /> "ON MI1;D.APR.bINT)AENyISAfEr. TIME <br /> �a <br /> f1ATEl:9NFIRI4IE`D r PHONE FAXtu�Nf(lALS = . <br /> T. <br /> MMIEWED YES NO REVIEW DATE: <br /> etw unxnoc y <br /> atarsoo� Lg ' ' <br />