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02/16/2006 11 :39 FAX Z 003/003 <br /> oa, itEcr:iv ;•�1 0 <br /> C.IYSJ LVV 1\VIIV LI1 <br /> SAN JOAQUIN COUNTY <br /> ENvmon ENTAL REALTH DEPARTi iNa <br /> 304 E Weber Ave 3'1 Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209)464-0138 Web:www.co.san joaquin.ca.Us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> �� � �r- n��CQ'S <br /> APPLICANT: ,�Y1 i5fwlyS 6USINESSIAGENCY;�flt�l jC <br /> ADORESS: <br /> PHONE: 13y!5! FACSIM LE. ?9) S 06,21 <br /> iV <br /> TENTATT-_ EW'APPOINTMDATE a II1 Tkne: VO <br /> (Please allow 10 business days from date of applicatlon submitlal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTDATE a7I�G <br /> Deoarbmnt Use Onto <br /> FILE ADDRESS UNIT <br /> Afed 44 Q Unit 1 <br /> i s+� /.r _}7 S <br /> oo ,, r, r Unit 2 Q <br /> s t z Pqym, CH .1, -4 V <br /> s. suaa <br /> 11110i Aj. efrom R , r Unit 3 �/ 1 <br /> I17 #1 Slat rauke q9 F f'I <br /> T- t -,, 'RR , , F, Unit 4 <br /> �. suw 113-11 { 3 '1 a� a" � Unit 5 <br /> ,o. sand - G • <br /> ENVIRONMENTAL HE.AL.TH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEAt1UP SITE(LOP) Q HOUSING ABAiEMEN7 9Lsouo WASTE FACILr.TY <br /> OTHER CLEANUP SrM(NON-LOP) 0 FOOD FACILITY ❑ Sc"b WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGM5MOVAL) d DCG KENNET. lig-DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH U-PKG TREATMENT PLANT <br /> ❑ 'nFRED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER 7RUCKrYARDICHEM TOILETS <br /> 0 TATTO01800Y PIERCING ❑ POouSPA M LAND USE APPLICATION SrTES <br /> ❑ MFOICAL WASTE FACILITY O OTHER(PL5A.S1_SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of rites from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0136 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. A new <br /> application may be submitted when the file is available. <br /> 4. Any File not retumed in the same condition as released will be reorganized by END 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 /> .050 L MED.•AP.P01AfTM•ENT�"ATE TIME " :'`".;�_ <br /> DATE CONFIRMED PHONE FAX ' -1NfT1ALS y s•"' <br /> REVIEWED YES N0 REVIEW[)ATE, '- :.•. <br /> ' eH0�1.a2-0Oi ' <br />