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11/08/2004 14:46 2094671118 AGE STOCKTON PAGE 01/0 <br /> EHD LOG NUMBER <br /> SAN JOAQUIN COUNW <br /> ENVIRONMENTAL HEALTH DuARTMEIN ZO N Q V 0 8 2004 304 L Weber Ave 34 Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:www.co,san-joaquin.ca.us/ehd <br /> - '•': )i'S'i';i AT H-ALT H <br /> I: ;`,A T/SERVICES pUB1,1C RECORDS RELEASE APPLICATION <br /> APPLICANT: USINESS/AGRNCY: <br /> 1 17 <br /> ADDRESS: fA 1 <br /> PHONE: �' FACSIMILE:_RO Y/J i 7��/]--!�' <br /> TENTATIVE"APPOINTMENT DATE: Time: �r�'//�,u/ <br /> (Plaasa allow 10 business days a tram data of application submittal) A0 r�+G/ <br /> CHECK BOX TO EXPEDITE REQUE -$ .W FEE—REQUEST ESSE LN 3 BUSINESS DAYS <br /> 1 , <br /> SIGNATURE OF APPLICANT - _ _�-_ DATE <br /> -_— <br /> -- - f�l <br /> v r Department Use OnIY <br /> FILE ADDRESS U.N1T <br /> QRS � 3 .. Y? <br /> �. street cUnit 1❑ <br /> z stroe! <br /> G � <br /> 3. snae< 3 � b _ ,� b �1 �Unit 2 <br /> 4. sheet "=:Iµ <br /> s. 8t:eet It FranUl JWDQLCK(;-�5 <br /> 6. stree! ity <br /> 7. stm6t c:ty Unit 4 <br /> s, sty <br /> s. street city (� Unit 5 <br /> 1 a. sheet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> THER CLEANUP SITE(NON-LOP) © FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) In 000 KENNEL ❑ DAIRY <br /> AZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> © TIERED PERMITTED FACILITY ❑ MOTEL(HOTEL El PUMPER TRUCKIYARDlCHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY Cl OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above, Select the type(s)of flies from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the <br /> aaaresS ifICJCaYuu auuv�:. <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 /> 5. *TENTATIVE appointment dates must be confirmed with EHD Staff. <br /> G, Applications received after 3:00 pm wi',l be processed the next business day. <br /> CONFIRMED APPO(NTIi11EN . <br /> T DATE.... <br /> TtME::. <br /> DATE:CdN ;RMED P i7 FAX, N4TIALS <br /> Flt iH :' <br /> ".. <br /> REVI: D: YES;::. .,.... N0: REV-IeW15A7E::'•. •,:•::.......... ......... <br /> EHD WU-406 <br /> etwzooa <br />