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06/14/2004 16:13 FAX 209 9480621 [6 002 <br /> rc= ATE RECEIVED <br /> SAN JOAQUIN COUNTY <br /> 4 �� `]J ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave P Floor Stockton, CA 95205 <br /> J UN 14 2x((409)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/clid <br /> ENVIRONMEN1 HEALTH pUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Q N eeai BUSINESSIAGENCY: <br /> ADDRESS: ag <br /> PHONE: 6110 9 FACSIMILE: Oa_ D l_�--I Y g d(a — -. <br /> TE TATIVE*APPOINTMENT DATE: 114?/ d 3 Time: <br /> -(Please allow 10 business days fro M! date of application submittal) <br /> ji <br /> CHECK BOX TO EXPEDITE REQUEST=$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Departrnent Use Only <br /> FILE ADDRESS UNIT <br /> ,. cty- <br /> 04 unit 1 <br /> 3. s+reee a .*t B <br /> Iz a u L �t? �G �1J D Unit 2r f Y <br /> f. srned b �" i� Sfrt LD - <br /> S. Street OU Vlt Df a :�. "'� - d"L <br /> Unit 3 <br /> a. sweetcityLD <br /> T. streetCRY Unit 4 <br /> rn s. Sweet - Ci(I1_O <br /> a, street w6 G LU P-ty ❑ Unit S <br /> 10. sued G . <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES i <br /> J Y <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT. sono WASTE F L "" <br />'f OTHER CLEANUP SITE(NON-.OP) ❑ FOOD FACILITY CSOLID WASTE VE=HICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR C7 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> E3 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOUSPA :, ❑ LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFIC) <br /> c <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)46.4-013.8 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(16)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 tieing 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 /> 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 /> NF, M!'�, �AP<POINTM N A'fE' "'a y <br /> h_ <br /> ?AYI CONFIRMED }'PHONE -FA) . IT ALS <br /> t <br /> I tV(EWED YESNO REVIEW PATE <br /> EHD 48-02-006 �'�'• <br /> 6lEC.l00] _• a <br />