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04/06/2005 09:56 FAX 209 94806 <br /> 002/002 <br /> DATE RECEIVED �,,,,�„� ,,,.„�•. . <br /> SAN JOAQUL I COUNTY <br /> [ ECENVIED EI "RONIYIENTA.L REALT11 DEPARTMENT <br /> 304 E Weber Ave 3 Floor Stockton, CA95205 <br /> gWa <br /> t,�'N — G 200($09) 468-3420 Fax: (209) 464-0138 Web: www.cosaTl joaquin.ca.us/ehd � ((,, <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> nr nA,T/CC 1 Il FS <br /> i R <br /> APPLICANT: 71"04 BUSINESSIAGENCY. 1 141d <br /> ADDRESS- AR <br /> PHONE: f CRI 4 114 FACSIMILE: y- su �f 5 <br /> TENTATIVE-APPOINTMENT DATE: 7/ate Time: <br /> (Please allow 10 business days from date of application subminal) <br /> CHECK BOX TO EXPEDITE REQUEST-591.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTDATE <br /> r Department Use only <br /> FILE ADDRESS UNIT <br /> 5 a <br /> �1 ❑ Unit 1 <br /> z artd 40 — l,A... c <br /> a spa 1 e` a ' U DR 2 "I <br /> �Y1�/ltS a, s.IM 31-L a- <br /> j S. s� n c " Ir Unit <br /> F'ID U57 UU VUUUU <br /> 0. sued AA') v., a ^ <br /> I C� T. smx •Ov C " ZQ unit 4 <br /> "tzoUS e. sum oo Ae. v-e <br /> W I °as <br /> T. 9�4 su.e ; a TLet.3 cit, UnRS <br /> MSI- 10. Sega 1•t -0-.Ab CRY <br /> n <br /> 268K I� (,!%let `. 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE ft op) ❑ HOUSING ABATEMENT N.soLIo wAZMM FACILfTY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> I* UNDERGROUND TANK(MONRORINGIREMOVAL) ❑ DOG KENNEL BL DAIRY <br /> W HAZARDOUS WASTE GENERATOR O CHICKEN RANCH - 19L PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL 13 PUMPER TRUCK/YARDICHEM TOILETS '; <br /> E3TATTOOISCOY PIERCING 13POOLISPA Ito. 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. EHO 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. Thefiles <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 ne• <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 experts <br /> of the applicant. Future file reviews by the Same applicant may require a $93.00 deposit prior to revie <br /> S. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the nextbusiness day. <br /> _CONF�IRMF_DAF:P.OINTMENT'dATE <br /> ,TIME <br /> DATE CONFIRMED PHONE FAX '. '- ' 01fiALS <br /> REVIEWED ,_ YES NO REINEN DATE <br />