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�005 <br /> i� 28/2004 13:24 FAX 209 94806 �r ..R <br /> DATE R59EIVED SJAN OAQU N COUNTY <br /> ENMONMENTAL HEALTu DEPARTMENT <br /> 304 E Weber Ave 3"t Floor Stockton,CA 95205 <br /> (209)468-3420 Fax= (209)464-0138 Web:www.co.san joagilin.ca.us/chd. <br /> ./ <br /> ��) <br /> PUBLIC RECORDS RELEASE APP[L1ICATION <br /> APPLICANT: F 4y� cEi1�S _BUSINESSIAGENCY: <br /> ADDRESS: age }k LAjjr+LC. <br /> PHONE:, r'i`l8' C3'ys <br /> FAGSIMII,E: R -czar <br /> TENTATIVE'APPOINTMENT DATE: Irllilo� T1f°° �� <br /> (Please allow io business days from date of aPPlicaUon subendtaq <br /> ❑ CHECK BOX TO rxPEDRE REouFsT-$93.00 FEE—REQUEST PROCESSED a4 S BUSINESS DAYS <br /> ( � DATElt /MA/�h <br /> SIGNATURE OF APPLICANT ! Department Use Oriv <br /> UNIT ` <br /> FILE ADDRESS <br /> Pti�\ tiv� U t Unit 1 <br /> itl ,. sem+ 9 4�^ <br /> N(r __ t s:ee� L LCe%as- 'C2,v z {'on <br /> u,\So+. i••lfl UnR2 <br /> G <br /> s. seRe E <br /> Unit <br /> r, <br /> e. s°M C3 Unit 5 <br /> 9. SbeeS <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 49 SOLID WASTE FACILITY <br /> (ZL UNDERGROUND TANK(USC) ❑ FOOD FACILITY ❑ SOLID WASTE VEMCLE <br /> IN OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL IS DAIRY - <br /> B7 UNDERGROUND TANK(MONITORINGMXMOVAL) El HAZARDOUS <br /> RANCH PKG TREATMENT PLANT <br /> J4HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL ❑ PUMPER TRUCKrYARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOLISPA Yk LAND USE APPLICATION SITES <br /> ❑ TATTOOInOOY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> O MEDICAL WASTE FACKM <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above oy 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 he held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. Afile 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 /> a. 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 /> S. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> s. Applications received after 3:00 pm will be processed the next business day. <br /> ENTDP.TE <br /> EA <br /> MED`AePOitrM. 'ANE.: FAX''.:',, '�_;;..:i*.jNfTJALSNFIRMED . <br /> YES NO REVIEW DATE. ".j - - - <br /> D ,. , <br /> ewrzros <br />