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__---4)3/24/2004 10:35 FAX 209 948062 Z002/002 <br /> D�TR_2CEIVED <br /> SAN JOAQUIN COUNr'X <br /> �J <br /> ENVIRONMENTAL i NTAL HEALTE(DEPARTMENT <br /> MAR 2 4 2004 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax., (209)464-0138 Web:vAvw.co_san joaquin.ca us/ehd <br /> ENVIRON LN] hEAD h <br /> PER N1I11-'SERVICES PUBLXC )ECORDS RELEASE APPLICATION <br /> APPLICANT: ty�lS -Q/J L BUSINESSIAG_(ENCY: <br /> ADDRESS- c go7� /'(y/�T l� �Tock1 j1 �a <br /> PHONE: aOq 3U S FACSIMILE. <br /> TENTATIVE'APPOINTMENT DATE 3 q D Tune: II dO <br /> (Please allow 10 business days from date of application submittal) ! <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 3Cy <br /> DeparUmn Use Ofily <br /> FILE ADDRESS UNIT <br /> 1. seroc, • S�3 Ca ori O u p Unit 1 <br /> 9. sueei !oo ►v 100 Unit 2 _ kK <br /> rewAu e Yeb,11 N)6r AV Ad <br /> s. soca CRyUnit J <br /> 6. SocaDoy <br /> 7. Strr-51 Cky 1E0 Unit 4 <br /> L1e. sues <br /> 9. steel G ❑ Unit 5 <br /> 0. 54efl VA 0 N <br /> on <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT IR' SOLID WASH=FACILITY <br /> OTHER CLEANUP Sn-E(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WAIS-TE VEHICLE <br /> Er UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ DOG KENNEL Z DAIRY <br /> X HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH M PKG TREATMENT PLANT <br /> ❑ TIERED PERMrfTED FACILrTY ❑ MOTELMOTEL O,/PUMPER TRUCKrfARDICHEM TOILETS <br /> � <br /> ❑ TATTOOA300Y PIERCING d POOLISPA 9'.LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECJFY) <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)464-0138 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 EMD 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 X93.00 de osR PrigLtobleviAw. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. VU <br /> 6. Applications received after 3:00 pm will be processed the next business dah: <br /> y <br /> -.CON IR ED APPOINTMENT DA4TE -r TIME ice_•' r.,. <br /> . .. <br /> :DAT I-CONFIp,M1tb - ;.PHONE . FAX <br /> kLV!,EVV.ED YES NO REVIEW DATE <br /> EHO 4""06 - - <br /> V=003 <br />