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7 <br /> 06/14/2005 14:10 209361-" 128 NEIL ANDERSON=-'IRO PAGE 02/0' <br /> DATE RECEIVED <br /> EHD LOGIVUME <br /> SAN JOA,QUIN COUNTY, i <br /> D I I : S D ENVIRONMENTAL HEALTH 11EPA�tTMENT <br /> `J 304 E'Weber Ave 3rd Floor Stockton, CA 95205 - <br /> (209) 468-3420 fax: (249)464-0138 Web: WWW' sanjoaquica.us/chd f <br /> JIB 7005 <br /> ENVIRONM PUBLIC RECORDS RELEASE APPLICATION <br /> ELU PERI` IT/SERVI1ES �] , <br /> APPLICANT: I'- CSG[rte RUSiNE551AGENCY: <br /> ADDRESS; d ` OjAx"r <br /> PHONE: FACSIMILE:-" Z <br /> TENTATIVE*APPOINTMENT DATE:„ P� D I rrrie: ` 0 <br /> (Please allow 10 business days from date of a�pplicatipn submittal) <br /> E <br /> CHECK BOX TO EXPEDITE REQUEST-$ 3.00 FEE EQUEST PROCESSED IIN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT" <br /> DATE1114- <br /> Department Use Only <br /> FIDE ADDRSSS I UNIT . <br /> sure, <br /> 19 S Sk �+� } r!• ❑ Unit 1 <br /> 2 Street 0 L 25• si- CR <br /> 3. S, t Ila �3 u• S�• ' ❑ Unit 2 <br /> 4 cily <br /> ll <br /> s. s,ree, a� Unit 3 <br /> s. Sim- aly1 <br /> r. s,rces C, I nft4` <br /> Strecl at I <br /> � Unit 5 <br /> 10. street CRYI <br /> 4 I!! <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VE141CLE <br /> i <br /> UNDERGROUND TANK(MONtTORINGIREMOVAL) © DOG KENNEL ❑ DAIRY <br /> WASTE GENERATOR <br /> t7 CHICKEN RANCH ❑ PKG TREATMENT PLANT i <br /> HAZARDOUS ,3 ❑ PUMPEFt TFtUCK/YARPIGHEhA T00.E <br /> TIER90 PERMITTED FACIWTY ❑ MOTEL/HOTEL <br /> • ❑ TATT00I80DY PIERCING <br /> 0 POOUSPA o 0 LAND USE APPLICATION SITES <br /> © MEDICAL WASTE FACILITY 17 OTHER(PLt;ASE SPEI�CIFY) -- <br /> 1. List up to ten addresses in the space above. Select the type(s)j of files from the fist above by checM ) <br /> the appropriate box(es). At least one file type MUST be Selected. Fax to 209 464-013S.Or mail tot <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist An aippointment for review will be confirmed t <br /> approximately five business days but no tater than tort(10) days after receipt of application. The fi <br /> will be held for a maximum of five business days for review. Appointments should be scheduled k <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may,not be'limmediately available for review. A w <br /> application may be submitted when the file is available.I. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the exp( e ! <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to re, w. <br /> 5. *TENTATIVE appointment dates must be confirmed wittil EHD staff. - <br /> f 6. Applications received after 3:00 prn will be processed the nextfbusiness day. <br />'I TIME <br /> CONFIRMED APPOINTMENT DATE <br /> DATE CONFIRMED -_ PHONE FAX INITIALS <br /> II REVIEWED YES NO REVIEW DATE <br /> EHD AP-oa-006 <br /> BV20o3 if <br />