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Jun, 2. 2005 2: 57PM A�NCED GEO � ' No, 0833 P. 1 <br /> DATE RECEIVED <br /> /a LI L=Ii l� SAN JOAQUIPT COUlV fY EHD LOG NUMBER <br /> Ifl ill(LLE 1 II ENVIRoNmENTAL HEALTH 'NT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> ani _ <br /> SUN 0 � Z�3)468-3420 Fax: (209)464-0138 Web, Www.co,san-joaquin.ca.us/ehd Q / <br /> ENVIRONMENT HERLTH P LIC RECORDS RELEASE APPLICATIONS 0 IQ <br /> APPLICANT; �Q � q y4,,�USINESSIAGENCY/�ad ed Edd Qo&( Iy/J//IPII Fd <br /> ADDRESS:.�7 3^ s oc 0//7y_ sJ Aj + _. <br /> PHONE:_"9- yr// /` IO.(, _FACSIMILE: O7,-�t,, 7 / ` � ^ F,: -_ :. <br /> TENTATIVE*APPOINTMENT DATE: & OS ^u-4d Tim: -IM JUN r <br /> (Please to /�(1�bus n from of apPII enn submitral) p/ Ali <br /> CHECK BOX TO EXPEDITE REO ST- I) FEE'R Y <br /> PRO E5 D�USINESS DAYS <br /> SIGNATURE OF APPLICANT DATE �' C <br /> . DePanme----��J <br /> a,� 6/90S <br /> I•wr� FILE ADDRESS <br /> UNIT <br /> olq�� eel SKr <br /> seem K L• 9 Z CRy ❑ Unit t <br /> s Sweet <br /> J I� d sees U/ ❑ Unit 2 <br /> Q <br /> r a: soe.l <br /> l". Unit 3 <br /> e sv�n 7` <br /> 4ST z Seen d UI S _.. <br /> u5'r 9, sftK U e Unit 4 <br /> F+� usr a saeOlt ft1/� CRIJ I f 10. See. G. unit 5 <br /> t <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILESUlt <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT M SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK <br /> GENERATOR <br /> ❑ CHI KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YAROfCHEM TOILETS <br /> ❑ TATTOo/BODY PIERCING ❑ POOLISPA Q 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. A file that is actively being worked on by EHD staff may not be immediately available for review. Anew <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 he confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> ( QNF)RMW APPOINTMENT DATE <br /> 71ME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Gib ae-0x-0oe <br /> BlBima7 <br />