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Nov. 16. 2005 11 : 12AM Ac' ced Geohvironmental No, 2965 P. 1/2 **../ DATE RECEIVEDSAN JOAQUIN COUNTY EHD LOG NUMBER ENVIRONMENTAL HEALTTT DEPARTMENT b 304 E Weber Ave 3 R L1Ulj p �� a IJL�A.I�� Floor Stockton,CA 95205 468-3420 Fax: (209)464-0138 Web: www.co.san joaquin,ca.us/ehd p� � f toq�tin.. ��c ash D l PUBLIC RECORDS RELEASE APPLICATION Mor jai,' Le�fq&� APPLICANT: j!�/ ` "' 'G �Q BUSINESSIAGENCY:/14 l�L-" ADDRESS: L7��!77 djC(,� PHONE: 'Ap -`� FACSIMILE: 4&-7 zA TENTATIVE"APPOINTMENT DATE: v � Time: (Please allow 10 businsss days from data of application submittal) CHECK BOX TO EXPEDITE REQUEST-$93.00 FET=—REQUEST PROCESSED INS BUSINESS DAYS SIGNATURE OF APPLICANT 0MA0Z DATE ` Qq � L� P.4O 1Id„w-- Department Use Only FILE ADDRESS UNIT ca st-N 16 CKY ❑ Unit 1 3. Stroet atv 4. street ❑ Unit 2 s. street CRY e. street cfty ❑ Unit 3 7. street City rt TIM e. street ell Unit 4 e. srreec 10steer ❑ Unit 5 ENVIRONMENTAL HEALTH DEPARTMENT FILES Y� UNDERGROUND TANK(UST)CLEANUP SIT LOP ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY OTHER CLEANUP SITE(NON-LOP) A FOOD FACILITY ❑ SOLID WASTE WHICLE 0 UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT CI TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKWARD/CHEM TOILEir§n\I 13 TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. 2. EHD will notify,the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten(10)days after receipt of application, The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new application may be submitted when the file Is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review, 6. "'TENTATIVE appointment dates must be confirmed with EHb staff. 6. Applications received after 3:00 pm will be processed the next business day. _ ILII ....... .. _..�[,r•�. /�rr�,]�[(�,}r�nwljj� 1�,y{.yr�'r .. -- •..................................t�r.4 Ifl rll rllfrv�'r111.�tt:Yli .. �::�ni w�� .-�'.�G. .-.li 114( .. a.:r . .-_......... ... ._-.:...:�.:.:t•u..ur i��t•i ...._.-....._..........-.._.__.............._:4:•:::_:�-:'-' . NIh.1.41k/11'ffMr'irh�-:^r.::.,i:....-..:-...:....::-._:::.:::.--:.-.-__:- !: r hnl.:l dl !f r ..... p nwr4'rr:n.'nr,�•r"•lin^:-.::_:........................ ... 'Yip".�4:r`.N::.:.:._:::::.:::=.� _II.W200 /6's —M ....-.:-... rA{>Ilr.:tilrh:l."•rJ.r:4rpfrW.:�.r:i�:.__..:....�:._'-..:., d.lrl.i)P}II.1141 ::.1Ci:^1:.1'i:: idllnlr�:i�1�41r�. .-...... �-�'"�'�-.—__..n�::.:.::: .............1::67�1d4frt.'�tair/ex4/rclmflll�,•.•G...:r_._...,..-..r.-.,.,1'1179-�YY' —= ....._._._._..............__..--..-...,_... ._. .....__-_._ ..- ::_:_s:.:_:.-tin.. _ c H.M.t•.._:v�:!-:a::t::•_.'_:_::•:_::_'_:_�_�::.:-"-.....i::fh`f�41M4:ty�[fHY:r _ ..�t��r ]ten........-_._.-........_. I.I r.!.1..'r:t:.:r:...�::'.._ :..:.:_::.:.::::�::::-::::::•:-:: :.4 1 :lt...uMiirciMrhil>.4`.'?..;_�: ..� ..I,!vY._..'-..-_•.::::__,.iii �7 _ -..-_ 1% i.•(��Wit.. ...-._......................._._.-,....-._.--.{:.::::::: -:::r1r.��r.� .-.-.-.._.....:E:7�:�-_-::f'.:-:'_:_�'.T.iz:a:�'.t./,Y.r•/ �i.1 ....._._.-...._.-._....-.._.._.. 1 M/ld�:<�W'.._-�:::i�iiJ:�::ii-'::�.: