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\ ' 06/03/2004 10:24 2094671 AGE STOCKTON go PAGE 01/0 <br /> V DATE RECEIVED EHO LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> HECEh4l E 304 E Weber <br /> AvAL HEALTH DEP�z95205 <br /> l� 31k1 E Weber Ave 3`4 Floor Stockton, CA 95205 <br /> JUN 0 3 2&)468-3420 Fax: (209) 464-01.38 Web: www.co.san-joaquin.ca.u,,;/ehd <br /> PUBLIC RECORDS RELEASE jA�PPLI]CATION <br /> ARI@a4� (`��li �f , ^ . CBUSINESSIAAGG.ENCY:�Q/fQ�t(f�CPO 1J J)U/+ I177�QR <br /> ADDRESS: 2SJ ! J�7 W w� , si Uy � y �eII �j <br /> PHONE: _�pg- �k/"IDO� FACSIMILE: <br /> I <br /> TENTATIVE'APPOINTMENT DATE: ` ZLCS L11in Q Time: <br /> (Please allow 10 business days from date of appllcatlon submitfaq Z/11 Carne *)JM y <br /> x CHECK BOX TO EXPEDITE REQUES -S9 AO FEE—REQUEST ROCE ED IN 3 BUSINESS DAYSAOt <br /> SIGNATURE OF APPLICANT DATEWU y <br /> 0Ar�� anmernuseONv <br /> FILEADORESS 'C �I ( I I _ „yn UNIT <br /> sow �p L� c [J Unk 1 <br /> ,fop ` s 11 tQ c <br /> flYti 3, seee/ <br /> — <br /> e. 5ne< D R SSI Unit 2 <br /> s srvn $ Ct I t1 nit 3 <br /> 7. s E. _ K C n1t4 <br /> s ,2370_ Cq <br /> —8Aglow <br /> 0!"t] Unit <br /> 10, s�a a 3 S .—E uJ- c <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES � 3 i9 <br /> UNDERGROUNn TANK(UST)CLEANUP SITE(LOP) CI HOUSING ABATEMENT CI SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK ORINGlREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> nEREO PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOO/eODY PIERCING ❑ POOLISPA .LAND USE APPUCATION SITES <br /> ❑ MEDICAL WASTE FACIUTY ❑ 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)464-0136 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 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 /> 9. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6, Applications received after 3:00 pm will be processed the next business day. ( "� a <br /> c +� <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Ghetl c 65 rnad pek- `u zann e I l,?ovkt <br />