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0002/002 <br /> 6/2005 09:58 FAX 209 9980e" <br /> low <br /> in D SAN JOAQM COUNTY <br /> RELIEVED EngRONM.ENTAL HEALTHDEPARTTY ENT <br /> 304 E Weber'Ave 3`1 Floor Stockton,CA 95205 <br /> 200 09) 468-3420 Fax- (209)464-0138 Web: www_co.san joagwII.ca.us/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> "USINESSlAGENCY: f�I;1 �der <br /> APPLICANT: W- x <br /> ADDRESS: <br /> /� n1� FACSIMILE: <br /> PHONE:yA��ti+� I / Time: <br /> - <br /> TENTA7IVE'APPOINTMENT GATE: <br /> (Please allow 10 businaea days from date of application submittal) <br /> CHECK BOX TO"PEDfTE REOUEs r-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> PATE �� <br /> SIGNATURE Or APPLICANT Oeoa,mcntUseD 'v <br /> UNIT <br /> FILE ADDRESS <br /> M <br /> 5 a L3 Unit 1 h AST s. W i 0 S <br /> L-LS7 z arn. yo _ a u U R2 <br /> R' <br /> ,,�.L P y S <br /> VT'W It.tS a. b1ee1 1 1r� <br /> G a ILII Unita <br /> {1�1J 1%Ax rUVUu <br /> G <br /> t ST a svx, 9 d ' n 20 Unit 4 <br /> us -. ---- DO �' G Unit 5 <br /> 1W <br /> \1+W I MSY ta. Sam .ht •ear) � � t <br /> 2-()16'6 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 8L SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) LlHOUSING FACILITY <br /> ENY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON10P) EJ FOOD F g DAIRY <br /> I& UNDERGROUND TANK(MONrrORINGIREMOVAL) ❑ DOG KENNNELNeL I9L PKG TREATMENT PLANT <br /> ffi HAZARDOUS WASTE GENRANCH <br /> GENERATOR LI CHICKEN R <br /> ❑ MOTELIHOTEL ❑ PUMPERTRUCKIYARDICHEMTOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOLtSPA IA LAND USE APPLICATION SITES +' <br /> ❑ TATTOOMOOY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> of files from the list above by checking <br /> 1. t.ist up to ten addresses in the space above. Select the type(s) <br /> the appropriate bax(es). At least one File type MUST be selected. Fax to 209 464-0138 or mail to the <br /> addressindicated above. <br /> 2. EHO 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 he Immediately available for review. A ne+ <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 expens <br /> of the applicant Future file reviews by the same applicant may require a$93.00 deposit prior to revie <br /> G. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> g- Applications received after 3:00 pm will be processed the nextbusiness day, <br /> �` :K-� .• ,•:;..: .•TIME <br /> taN1R�inAP?bit�riiiy <br /> NTi�aTrt _.. .: ,, : <br /> . ,., r <br /> bATECONFIRMED PHONE . FAX' `. "' :91N�°LS <br /> REVIEVVFD YES NO REVIEW DATE <br />