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. 10/30/2003 11:19 FAX_ Q001 <br /> DATE RECEIVED- EHD LOG NUMBER, <br /> - SAN JOAQUIN COUNTY. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> v T 3 0 2003 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> t (209)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> 7/147-7— :S`M,j"_E / BUSINESS/AGENCY: <br /> ADDRESS: D Cq�'II,p- t'2IV6� ./4v /� /LVCl� �2iv7[aeVr77MF/✓� C/� QS��C� <br /> PHONE: ��(J lJr�6 �2��5~ FACSIMILE: <br /> / ,A <br /> TENTATIVE`APPOINTMENT DATE: A"UV 47$4 2/w,3 Time: 1017 <br /> (Please allow 10 business days from dale of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.010 FEE RE�EST PROCESSED IN 3 BUSINESS DAYS J <br /> SIGNATURE OF APPLICANT ��" "' DATE / U -31(9—C):3 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. Streel Zile0 Unit 1 <br /> 2. Slreel 0 fn/1.$! /n1 •` Qq l VI^ Cil 7-Mk-1 <br /> J. Slreel City ❑ Unit 2 <br /> 4. Street Cit -�V�. <br /> 5. Street Gl ❑ <br /> 6. Slreel city <br /> 7. Slreel City Un <br /> 8. Streel Cil <br /> 9. Street City Unit 5 <br /> 10. Streel Cii <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 ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM 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 /> EHO 48-02-006 <br /> 3181200 <br />