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V RDA'icRECEIVEU <br /> L SAN JOAQUIN COUNTY arlu wu Ntst.ascl< <br /> C_I11�%� �[jl EN,_IRONMENICAr. �F EALTHDEPARTIVLENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 I /n <br /> NOV 1 4 2003 (209) 468-3420 Fax: (209) 464-0138 Web. wwwa.5an joaquin.ca.uUthd <br /> ENVIRUNMEN i HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT-'y_0M -Kv,q4ae BUSINESSIAGENCY:. <br /> AODRESS: k7 'Xi -1mKi4j, <br /> PHONE: —i M;;eb FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (please allow 10 buslness days from dale Of appllcallon submittal) R9 <br /> 12 CHECK BOX TO EXPEDITE REQUEST-393.00 FEE—REQUES PROCEssED IN 3 BUSINESS DAYS I NOV 14 003 <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> U5T FILE ADDRESS ? UNIT <br /> I. steal <br /> w J <br /> 2. avtlel c; Unit 1 14 <br /> s. Sir"tWin ��� 1 �� 11 <br /> aye <br /> B. SV1W � PI "' Unit <br /> sv441 ^i i �'! �� GI ✓ / &Unit4 <br /> to, siren _J - n _ city -) Unit 5 <br /> __ // ENVIRONMENTAL HEALTH DEPARTMENT FILES u�+ <br /> K}iNDERGROUND TANK(UST)CLEANUP SITE(LOP) �uSING ABATEMENT ❑ SOLID WASTE FACILITY C!' <br /> 1�THER CLEANUP SITE(NON-LOP) FOOD FACILITY ❑ SOLID WASTE VEHICLE ' <br /> �����ERGROUNO TANK(MONITORING/REMOVAL) ❑ DOG KENNEL l7 DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PK TREATMENT PLANT <br /> ❑❑❑ TIERED PERMITTED FACILITY 0 MOTEUHOTEL ❑ MPER TRUCKIYgRDICHEM TOILETSEl7A7T007BODY PIERCING ❑ POOUSPA LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the types) of files from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 2091 464-D138 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 /> s. 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$93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIAL$ <br /> REVIEWED YES NO REVIEW DATE <br /> EEHD4442444 <br /> av2sss <br />