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10/30/2003 .1- :19 FAX <br /> Z 0 01 <br /> DATE RECEIVED l✓ �� EHD LOG NUMBER. <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH.DEPARTMENT <br /> "" 32003 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/chd <br /> '} PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> 3,)&4— <br /> f14/ T/✓S/L1,4L4,6y BUSINESSIAGENCY:: �V ct-- �`T GNVl&(�Al/t'L1W-1)7L <br /> ADDRESS: 3,))&4—!pl`J,(� C.�MI� 0x2 Vey .�S�t l� /� WCJ 5/vJG V MF�✓T'O �/9 QS6�Q <br /> PHONE: f16 IJJJ �2��5� FACSIMILE: NIA <br /> TENTATIVE`APPOINTMENT DATE: NUV /4-7P/ 2CV3 Time: 1019'1 <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FE REEST PROCESSED IN 3 BUSINESS DAYS U J!, <br /> SIGNATURE OF APPLICANT DATE / _30—U 3 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. street 21 i ,yjW,4 i3O C,t $T 7V^j ❑ Unit 1 <br /> 2. Street ' 0 W%-Si Int o 0$IVf cit 7-&C;._I <br /> 3. Street Cit ❑ Unit 2 3 <br /> 4. Suet citAli <br /> 5. Street U ❑ U \/^� <br /> 64 street city crt Un �"C <br /> 7. Street ' <br /> e. street Cit <br /> I. Street Cil C1 Unit 5 <br /> 10 Street cit <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> END 48-02-006 <br /> 3=2003 <br />