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08/25/03 MON 11:08 FAX 916 306 7013 KLEINF'ELDER _ p 00 <br /> • EHD LOG NUMBER <br /> DATE RECEIVED ' SAN JOAQUIN COUNTY 1-o" <br /> HEALTH EALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> ?(2b9�* -3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca-us/ehd I� <br /> " PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: yT�",l(� BUSINESSIAGENCY: <br /> ADDRESS: 3��� Tfi G✓C � 1P I <br /> PHONE: o(La)3LO(0— (-Ib I FACSIMILE: �)(V)r (O �b]•3 <br /> TENTATIVE"APPOINTMENT DATE: AfVIATime: <br /> (Please allow 10 busines ly tro=to of app kation submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-093.00 FEE-REO ST PROCESSED IN 3 BUSINESS DAYS f <br /> SIGNATURE OF APPLICANT )/I�i 1NGC� �- DATE 25 0 3 <br /> Department Use Only <br /> FILE ADDRESS UNIT ��31 <br /> sv<« 5 �• C' ❑ Unit 1 <br /> z. sa <br /> i. svw o-<er 6oco5 - Lal- YDA a Unit2 <br /> Street L d <br /> 5. svw I S CI xxpx� <br /> e. so-en <br /> CI .;?16. �a. �� •; <br /> str<e I3 S, c Unit 4 <br /> e. swat of <br /> e. sem« 3 CI Unit 5 <br /> 10. sircN CI <br /> ENVIRONMENTAL HEALTH DEPARTMENT F�€fi _8 2003 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WASTE FACILITY <br /> TR CLEANUP SITE(NON-LOP) FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL $DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ ERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY 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. 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 /> 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 INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD< 024 B <br /> venom <br />