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09/27/2004' 16:13 FAX 209 94806 <br /> �nitrct�tivty - - <br /> - Qj 002 <br /> SAN J'OAQUIN COUNTY <br /> RD tc 'j ���'� Errv�ztorrmMrrrAi HEALTH DEPATi x <br /> 304 E Weber Ave 3'Floor Stockton, CA 95205 <br /> SEP 2 7 Z00 z09)468-3420 Fax: (209)464-0138 Web:www.CO-san joaquia.ra.us/ebd <br /> ENVIRIJNN15i HEALTH VV <br /> ,�J�uBvlus PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT J) <br /> BUSUIESSJAGENCY;��`Cj�i'yf(r14.1� _ <br /> ADDRESS: Pxary mil! St xwg1� <br /> PHONE: qqg -') FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE:_ r0I7 ha <br /> (Please allow 10 business from data of a i <br /> days ppl oAon submlttiQ <br /> CHECK BOX TO EXPEDITE REQUEST-$97.00 FEE,REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 9�/�i 'I_ <br /> Deoarhwd Use ONy <br /> FILE ADDRESS UNIT <br /> t. sacra 'OO 2Sj' 'Q, U G 1 G <br /> IJI�� z sacs ) u c dtvC I ❑ Unit 1 <br /> NZ• <br /> r�S6y <br /> 14 Jfht I c n/,"r. " U;12 I yf <br /> s. Sacof <br /> s. sacq Unit 3 <br /> emw 000 <br /> 7, SaeG <br /> e. saw o Unit 4 <br /> 9. Shoe \vl <br /> ❑ Unft 5 <br /> 'ENVIRONMENTAL HEALTH DEPARTMENT FILES x <br /> Y UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT OL SOLID WASTE FACILITY <br /> !4 OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> ®• UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ®.pA,l� <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 8�pKG TREATMENT PLANTAM <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPERTRUCK/YARD/CHEM TOILETS <br /> 0 TATTOOtSOOY PIERCING P POOL/SPA ®. LAND USE APPLICATION SITES <br /> E3 MEDICAL WASTE FACILITY Ig OTHER(PLEASE SPECIFY) Az l�Frn 1:.� •f'=•.T Ada Sj <br /> 1. List up to ten addresses in the space above. Select the type($)of files from the list aboye by checking <br /> the appropriate box(es). At least one rile 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. 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 Vile 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 /> G. Applications received after 3:00 pm will be processed the next business day. <br /> CON��fRMED`%1P,POINTFA( NY iiA7 , :r . "`'` r' <br /> .TIME 7 '• <br /> :: `:• , ;t <br /> DATE�QNF r <br /> LRMED; �.}PHONEFAX" <br /> . <br /> vlNf>IALS �'. <br /> 1ZEV(EWM YES NO REVIEW DATE' <br /> ' eno uazaae <br /> aaeoaz <br />