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014T€RECEIVED SAN JOI=Hp LOG NUMBER <br /> � <br /> j{�,�] n A,QIJIN COUNTY U V IS�i ENVTRONMI' TA L HEALTH DFS' NT <br /> 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> MAR 1 G 2005 (209) 46$3420 rax; (209)464-0138 Web: www.co.san joaquin.ca,us/elid <br /> 'INV r,� PUBLIC RECORDS RELEASE APPLICATION <br /> R� E BUSINESSIAGENCY: I " e f �✓ �� {5 �� C <br /> ADDRESS: at <br /> �- �, <br /> FACSIMILE: <br /> TENTATIVE,APPOINTMENT DATE: Time: <br /> Lboasealt,owLinessys from date of application srabmiaat) <br /> CHECK SOXTO EXPEDITE RT PROCESSED IN 3BUSINESS DAYS <br /> SIGNATURE OF APPLICANT GATE <br /> Dep2rtmenl Usc Only <br /> FILE ADDRESS UNIT <br /> city ei+j <br /> EJ Unit 1 <br /> 2. alMel a Clt <br /> � <br /> 3, SV-01 Mtv <br /> Fj Unit 2 11\ML <br /> 4, Sireel Cit n�Q <br /> 5, slreel <br /> CRY <br /> 6. $vel Cll <br /> T. strml Gl Unit 4 <br /> R, armr.1 till <br /> 6. strc=i CNIV Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> Pf'UNDERGROUND TANK(MONETORING1REMOVAL) C1 DOG KENNF-L ❑ DAIRY <br /> AZARDOUS WASTE GENERA-son 0 CHICKEN RANC14 ❑ PKG TREATMENT PLANT <br /> 7 TIERED PERMrrTED FACILITY ❑ MOTEUHOT5L ❑ PUMPER'fRUCK1YARD/CHEM TOILETS <br /> ❑ TATTOOfSODY PIE=RCING CO POOL15PA ❑ LAND USE APPLICATION SITES <br /> ¢ MVDICAL 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)464-013.3 or snail 1:6 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 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 x <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 4U-47,006 <br />