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09/27/2004 16:13 FA% 209 9480 <br />uhlcelvtu SAN JOAQUIN COUNTY <br />:,',rENVIRONMENTAL HEALTH DEPAkTMENT <br />304 E Weber Ave 3ie Floor Stockton, CA 95205 <br />SEP 2 7 Nq�09) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquinmus/ehd <br />ENV1F0'J LTH <br />Ir�cwlr.p.q PUBLIC RECORDS RELEASE APPLICATION <br />Le, <br />APPLICANT; I'f/.w ;_,J IJ7 _ BUSINESSIAGENCY: <br />ADDRESS: _t,Z, 25c; f- .. AVIA l(v_ '._, —rkAI p� <br />PHONE: 8149 -)3141 FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: 10l7 Time: <br />(Please allow 10 business days from da(® of application submittal) <br />0002 <br />Cl1V�6V V nv�•�...-.. <br />a031 <br />13 CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE- REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT r rr 2�✓ DATE <br />DeDAMT1Cnt Use Orgy <br />❑ Una t <br />d <br />Una 2 I� <br />❑ Una 5 <br />/A x� <br />ENVIRONMENTAL HFJU.TH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT EL SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON4.OP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />19- UNDERGROUND TANK (MONITORUNGJREMOVAL) ❑ DOG KERNEL EL DAIRY <br />M HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH Ei-PKC TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDJCHEM TOILETS <br />❑ TATTOOMODY PIERCING ❑ POOL/SPA U LAND USE AP LICATK)N SITES <br />❑ MEDICAL WASTE FACILITY Ila OTHER (PLEASE SPECif U .�—t. • ta14�n Tans 09 44*5.1_ <br />i <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list aboye 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 Tiles 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 A=HD staff. <br />G. Applications received after 3:00 pm will be processed the next business day. <br />CI�N�Il%MED AP,ROINT)r1�N7L1A7E. -'�; _ -TIME <br />'.^1v.:yJNFTIALS ` <br />:DATE-8-OL.IRN�ED :.PHONE i FAX'" ;,:':';:'•'.. . <br />.REVIEWED YES NO REVIEW DATE'' <br />We 2 <br />