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X003 <br /> 1l,f28/2004 13:24 FAX 209 94808 <br /> DATE REUEIVED ti SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL.HEALTH.DEPAR.TM[ENT <br /> 304 E Weber Ave 3"I Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:www.co.saD joaquin.ca.us/ehd <br /> Z,) <br /> pU]aLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BU�SIIN�ESSIAAGENGY: <br /> ADDRESS: �O e 1•t S� GM,/r+k i7l`��[.s-t �cYltrp <br /> PHONE: S 13yS FACSIMILE: R -cX�af <br /> TENTATIVE`APPOINTMENT DATE: 1rII I IOT"1 : <br /> (Please allow 10 business days from date of SPPII ail n submrtta0 <br /> ❑ CHECK BOX TO rxPEDTTE REQUEST-f9S9]_A'O FEEE—REQUEST PROCESSED IN 3 BUSINESS DAPS <br /> SIGNATURE OF APPLICANT �q DATE <br /> Department Use Odv <br /> FILE ADDRESS UNI t <br /> Unit <br /> N f'c z � L trekas- 'qv 'bn <br /> IS7- Ii NI _. a. 9Vll aggel <br /> yj "'Ill Lint CAY z kin Unit2 f <br /> �Gy�'\ • a A� oak Unit <br /> a. saes 1 Unit4 <br /> T. seer <br /> Unit 5 <br /> 9. Steel <br /> to, SMeel <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> &,4 UNDERGROUND TANK tUS17 CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> IS OTHER CLEANUP SITE(NON10P) 13 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ID UNDERGROUND TANK(MONIORINGMEMOVAL) ❑ DOC KENNEL 0' DAIRY <br /> ❑ CHICKEN RANCH U PKG TREATMENT PLANT <br /> 0 HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL ❑ PUMPER TRUCKrYARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOL/SPA RL LAND USE APPLICATION WES <br /> ❑ MEDICAL WASOOY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> CI etEOICALwasTEFAcxm <br /> 1. List up to ten addresses In the space above. Select the type(s)of files from the list above Py checking <br /> the appropriate box(es). Al least one file type MUST be selected. Fax to 209 464-0138 or mail toll <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. Anew <br /> application may be submitted when the rile 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 493.00 deposit prior to review <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> E• Applications received after 3:00 pm will be processed the next business day. <br /> E BATE. .`r ' - TIME= <br /> ;CONFIRM D`APpoitrrt�i t4r : .,,..: :.;. :,:`: <br /> DATE CONF)RMED. ON NIT. 5 <br /> FAX'; <br /> REVIEWED YES 'No REVIEW DAF E. -r :... <br /> EFS wazaae <br /> erasaor <br />