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101@1/2004 11:17-7-, 20946,71118 , . A6� 5TOCKTDN ; PAGE 0110 <br /> MTI EIV��. _- SAN JOAQUIN COUNTY <br /> FHDLOGNUMBER <br /> I�f r '1'.�,�C I[1j E+1v iRONMENTAL HEA TH AEPA 'I'MENT <br /> 0 C T Q 1 _2p 304 E Weber Ave 3rd Floor Stockton,CA 9520`5 <br /> 9)468-3420 Fax: (209)464-0138 Web: www.co.sani-joaquin.ca.us/ehd <br /> ENVIRCIN'[01FNT HEALTH <br /> PFi"!/4r P':,:r PUBLIC RECORDS RELEASE APPLICATION 0 <br /> ruirnh -�------ <br /> i <br /> APPLICANT: 9[NESSIAGENCY: 1� . <br /> ADDRESS: .-7/�b <br /> PHONE: ;tV'/ 7#p ��DQ FACSIMILE: 074 Wilk" <br /> TENTATIVE*APPOINTMENT DATE: � Q � Tlma: <br /> II j <br /> (Please allow 10 bualness days item date of appllcatlb n submittal} <br /> CHECK BOX TO EXPEDITE REQ T-$9 .00 FEE-REQUEST ROCESSED IN 3 BUSINESS DAYS ff <br /> SIGNATURE OF APPLICANT I ` DATE JQ Q <br /> I I Department Use Only <br /> PILE ADDRESS UNIT <br /> I. s,,., IA?lq JF W&LOr— ci �UW y ❑ Unit 4 <br /> Unit 2 <br /> 4 Slroel ^G U 4�: 0. <br /> s. Soret Unit3 <br /> a. Sheet ISI I} 4 <br /> i Unit # <br /> 8. sh+wt CILY <br /> a. evert d II. :7 ❑ Unit 5 <br /> to street -i <br /> II <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE'S } <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 1f 0 SOLID WASTE FACI <br /> R U <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 13 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK MONITORINGIREMOVAL ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> a 'TIERED PERMITTED FACILITY C MOTELIHOTEL 13 PUMPER TRUCKIYARDICHEM TOILETS <br /> Q TATTOOIBODY PIERCING ❑ POOLISPA , EILAND USE APPLICATION Srra"S <br /> ❑ MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPECIFY) I� :} <br /> 1. List up to ten addresses In the space above. Select the type(s)lof files Ifrom the list above by checking Ik <br /> the appropriate box(es). At least one file type MUST be selected. Fax fo(20814U-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. Appolntnents 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 mayj require a$93.00 deposit prior to review. I <br /> 5. *TENTATIVE appointment dates must be confirmed with EH stff <br /> a . <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> I? <br /> CONFIRMED;APPOINTMENT DATE <br /> TE <br /> DA CON1=tRMED ,- PHONE I"A;IC; .ftJiTfi4LS <br /> I. 'RE ; - <br /> Vl1=WED• YES- �.�w0' .• . . 'REVIEGIIi�A-TE <br /> x ae.oi-ooe - <br /> arenao9 <br /> la i <br /> E <br />