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01/14/2005 09:46 FAX 209 9480621 • <br /> 002/002 <br /> 7E RECEIVED - . . . . , . .._ <br /> SAN JOAQUIN COUNTY <br /> ��\ IlliL��LSOV�D E' NVIRONhIENTAL$EA.LxEEDEPA TMENT _ <br /> 304 E Weber Ave 3'd Door Stockton;CA 95205 ` q <br /> .;!'N 1 4(�§RR 468-3420 Fax: (209) 464-0138 Web: li v.cos In joagaia ca.usIchd I J 1 ? <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE A'pLICAT'ION <br /> APPLICANT:�f�w�•-' "�y�(fp �.�' <br /> BUSINESSIAGENCY:;f1. <br /> ADDRESS: '4i? Nr-ilt, •t-24 `" 't�+�. CtiA. L'tS�oS <br /> PHONE:_ gkg RthZ- { FACSIMIIL�E:� -oll - <br /> TENTATIVE'APPOINTMENT DATE: <br /> (Please allow i0 husi`oess days from data of application suhmiWl) <br /> CHECK BOX TO EXPEDITE REQUEST-593,00 PEE—REQUEST PROCESSED IN a BUSINESS DAYS 1 - <br /> SIGNATURE OF APPLICANTW DATE I 0 <br /> Del"ent Use only <br /> / �5 FILE ADDRESS UNIT1. sued V <br /> l� us z sues t CRYS ElUnit 1 <br /> 1 <br /> N jF a. sve� iolt 6 blvdcwr „ <br /> „all <br /> Unit2 <br /> s. s�eea tb Ino E <br /> u UA;:Unit 3 <br /> T,)Ii- 1. Street vvi CR N <br /> a. Unit 4 , <br /> 9, 54e i <br /> m. s.ee ❑ Unit 5 <br /> -ENVIRONMENTAL IIEALTH DEPARTMENT FILES VA <br /> UNDERGROUND TANK(UST)CLEANUP SRE(LDP) ❑ HOUSING ABATEMENT 5L SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILrfY ❑ 5000 WASTE VEHICLE <br /> ®- UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 0-DAIRY <br /> IS HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ISLPKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILRY ❑ MOTELIHOTEL ❑ PUMPER TRUCWYARDICHEM TOILETS <br /> ❑ TATTOOIBOOY PIERCING ❑ POOL/SPA In LAND USE APPLICATION STIES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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 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 atthe 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 EHD staff. <br /> 6• Applications received after 3.00 pm Will.be processed the next business day, <br /> . . <br /> `L�O�1F�F�h1 D p)3pOINTHMENI'DATE;�1: `—: ., ,TIME �!1 <br /> ;.. ..,.;._ ... .. . : ..w'..�,.. :::vrt:1•�', <br /> `DATE aNFI na'.r . <br /> .IkEVIEV1,ED YES NO <br /> REVIEW DATE' <br /> ' ENo is-a3aa6 �:, <br />