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05/19/2004 10:41 FAX 209 948062" - 0 002 <br /> DATE RECEIVEQ <br /> U.C?A\ V OAQ LJ1.1ti COUNTY <br /> r <br /> N MON11r NTA1; AL1 H EpARTMENT <br /> 304 E Weber Ave 3"'Fleur Stockton, CA 95205 6aq <br /> MAY 19 20 9)468-3420 Fax: (209)464-0138 Web:www.co.sanjoaquin-ca-us/chd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT. BUSINESSIAGENCY. <br /> ADDRESS- o;)$c?5 '(0— 5 <br /> PHONE: FACSIMaF: <br /> TENTATIVE*APPojKmENr DATE �� Q rn,e•�_ Q It' <br /> (Please allow 10 business days from dale of appr1w ion submitlatl) <br /> CHECK BOX TO F"EnfTE REQUEST-$93.00 FEE,REQUEST PRO,C�E3SE0 <br /> - IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �Oc/>� PATE <br /> De <br /> Pat4mttt Use OnIY <br /> FILE ADDRESS r !c i UNIT <br /> 1. str«, 1.716 Q L A-r# <br /> 2s ❑ Unit 1 .4# <br /> - <br /> 3- Ssm G *, ` 11 <br /> .. s a Unit 2 � <br /> 5- sb <br /> sued ci <br /> Unita �G <br /> 7- sued <br /> a spec Unit 4 <br /> s D <br /> ea. sred u ❑ Linn 5 <br /> 4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEMUP SITE{LOP) ❑ HOUSING ASATEMENT 0 SOLID WASTE F'ACILn Y <br /> OTHER CLEANUP smr-(NON-LOP) 17 FOOD FAr-mm ❑ SOLID WASTE VEHICLE <br /> UN0ERGROUND TANK(M9NITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> HAZARQUUS'wASTE GENERATOR d CHICKEN RANCH ❑ PKG'IREATMENT PLANT <br /> TIERED PERmrrTED FAciL" ID MOTELIHOTEL Q PUEAPER TRUC4VYARDIGHE4A TOR ETS <br /> ❑ TATTCK)MODY PIERCING 0 POOUSPA )K LAND USE APPLICATION srrES <br /> ❑ MEDICAL WASTE FACIt_rl Y ❑ OTHER(PLEASE SPECIFY) <br /> 1. List t!p to ten addresses in the space above. Select the type(s)of files from the list aboxe by checking <br /> the appropriate box(es). At least one file type MUST"be selected. Fax to(209)46.4-0138 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 fire business days btd 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 END staff may not be immediately available for review. Anew <br /> application may be submitted when the file iS available. <br /> 4. Any rile 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. i <br /> S. Applications received after 3:0013M will be processed the next business day. i <br /> I <br /> RM <br /> 1biF!P.01UTMIGHT LIATE: ��:'s,r_ .TIME <br /> ,•>�A#:r,-NF,1 14(E-U•' ,tpHOt1E NCII,4LS <br /> FAX :�- <br /> .REviEWED YES NO REVIEW DATE. ' r <br /> are+�.003 <br />