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0/02/2004 12:09 FAX 209 94806" <br />V DATE RECEIVED <br />SAN JOAQUINCOUNTY • <br />EN RoNMENTAL HEALTH DEPARTMENT <br />304 E Weber Ave 3rd Floor Stockton, CA 95205 <br />MAR 0 2 2004(209) 468-3420 Fax: (209) 464-0138 Web: www.cosan joaquia.ca us/ehd <br />ENVIRUNMEW HEA(H <br />P;QUIT,cF_fi,l _ PUBLIC RECORDS RELEASE APPLICATION <br />rm,ra.�;iiip <br />ADDRESS: <br />PHONE: <br />FACSIMILE:__ -L-t <br />fd002/002 <br />110 <br />SENTATNE•APPOINTMENT DATE: —-5 112-1 O4 Time: 12(70 <br />i (Please allow 10 business days from date of appligGon submittal) <br />CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE- REQUEST PR IN <br />SED IN ]BUSESS DAYS <br />SIGNATURE OF! APPLICANT DATE OLI <br />J; Deo nnwit Use Only <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />J T UNOERGROU11 <br />YO TANK (UST) CLEANUP SITE (LOP) <br />UNIT <br />HWSING ABATEMENT <br />p <br />Unit 1 <br />❑ <br />FOOD FACILITY <br />Unit 2 <br />$UNDERGROUW TANK(MONITORINGIREMOVAL) <br />❑ <br />Unit <br />*ff DAIRY <br />g HAZARDOUS WASTE GENERATOR <br />❑ <br />CHICKEN RANCH <br />Unit 4 <br />2004 <br />❑ <br />Unit s <br />J T UNOERGROU11 <br />YO TANK (UST) CLEANUP SITE (LOP) <br />❑ <br />HWSING ABATEMENT <br />m SOLID WASTE FACILITY <br />SC OTHER CLEANUP SITE (NON-I.OP) <br />❑ <br />FOOD FACILITY <br />❑ SOLID WASTE VEHICLE <br />$UNDERGROUW TANK(MONITORINGIREMOVAL) <br />❑ <br />DOG KENNEL <br />*ff DAIRY <br />g HAZARDOUS WASTE GENERATOR <br />❑ <br />CHICKEN RANCH <br />a PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY <br />❑ <br />MOTEL -HOTEL <br />❑ PUMPER TRUCK/YARDICHEM TOILETS <br />❑ TATTOOIBOD?. PIERCING <br />❑ <br />POOLISPA <br />8 LAND USE APPLICATK)N SRES <br />O MEDICAL WASTE FACILITY <br />❑ <br />OTHER (PLEASE SPECIFn <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. f=ax to f209) 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 />app' rJmately 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 />3. A rite 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. An file not returned In the same condition as released will be reorganized by EHD staff at the expense <br />of tfjia 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 />':VVnh:I,1�fA U APPOINTMENT DATE: . :TIME v'�..`.. .., <br />DATE -CONFIRMED .PHONE FAX ' .;ti4N1TlALS <br />.REVIEVVED I YES NO REVIEW DATE, = i i <br />