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10/01/2004' 11:17 2094G'71118 AGE STOCKTON PAGE 01/0 <br /> FHD LOG NUMBER <br /> 71'T77 EIVED .-r SAN JOA.QUIN COUNTY le <br /> U '�--4 ENVMONMENTAL HISALTH DEPAxiTMNT <br /> 304 E Weber Ave 3`a Floor Stockton,CA 95205 <br /> OCT 0 1 20 l�l'C <br /> �t19)468-3420 Fax: (209)464-0138 Web: www.co.San-joaqUm.ca.us/chd <br /> ENVIR01MIENT i1EALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PI= r, - i0r: + L�1Uin7it <br /> APPLICANT: Vl SINESSIAGFNCY: <br /> ADDRESS: �y OQ <br /> PHONE: ®1 D% ��-/ '/Dd lO FACSIMILE' Or <br /> TENTATIVE'APPOINTMENT DATE: �Ld —Tlmu: <br /> (Please allow 10 bualnOSS days fmm date of apPllCanon submittal) <br /> CHECK BOX TO EXPEDITE REO T•se .00 FEE-REQUEST ROCESSED IN 3 BUSINESS DAYS /Q <br /> SIGNATURE OF APPLICANT�.dt�lt/h L DATE n Q <br /> �-� � Department Uso Only <br /> UNIT <br /> r1LE ADDRESS ` ✓✓ <br /> 1, shael / 1''/'E 01 > E ❑ Unit 1 <br /> _ 7-OA, 3f5 /// <br /> a. seex vV ❑ Unit <br /> 5 LI D <br /> s. so-eel nl (�h <br /> Unit 4 <br /> S. Sm ' CI <br /> e. SVeel C I `V ❑ Unit 5 <br /> I 10. SVeMCKY <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACT- <br /> OTHER CLEANUP SITE(NON-LOP) C FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 4 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY O MOTELMOTEL O PUMPER TRUCKIYARDfCHEM TOILETS <br /> 0 TATTOOIBODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> Cl MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses In the space above. Select the type(r)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mall 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 /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. deft <br /> 6. Applications received after 3:00 pm Will be processed the next business day. <br /> CON FIRMED;APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX ANITIALS, <br /> REVIEWED YES "'N4 REVIEW DATE ' <br /> n .e.az.oac <br /> wavow <br />