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04/28/2004 14:53 2094671118 AGE STOCKTON PAGE 01/0 <br /> DATE RECEIVED � EHD LOG NUMBER <br /> APR 2 $ 2004 SAN JoAgUnv COUNTY <br /> I+NVT.RONmiNTAL HEALTH DEPARTmmNT <br /> 304 E Weber Ave 3'd Floor Stockton, CA 95205 -7 <br /> 468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/chd <br /> V PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: FkBUSINESS/AGENCY: UJ <br /> ADDRESS: ;7/1//�� /� l,/f1Q r' /41171 s- <br /> PHONE:_ O(D7. �� /. /1✓ FACSIMILE: A0 , �7/�//�.I�I&-_'X <br /> �/� <br /> TENTATIVE'APPOINTMENT DATE: 6-f-1_lQ� l ;0,6 7 Ti.:_&-_' / _ 164rh r <br /> (Please allow 10 business days from data of application submittal) lj• /paw.. . <br /> CHECK BOX TO EXPEDITE REQUY 3.00 FEE-REQUES P OCESSED IN 3 BUSINESS DAYS "���JJ <br /> (((SIGNATURE OF APPLICANT � DATEI A Y <br /> Departm nt Use Only <br /> FILE ADDRESS UNIT <br /> 1. sveec / 'MWG a <br /> z s ❑ Unit 1 <br /> a Street t r s r C' t <br /> a. S—b'" Q G f ❑ Unit 2 <br /> M7 <br /> smaa cn <br /> J7 <br /> £ � Unit 3 �J <br /> e. street � <br /> 7. sheet C 4 a <br /> Unit 4 <br /> P. street ° p Unit 5 <br /> 10. Street rity <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES >= <br /> Jjs <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13 HOUSING ABATEMENT ❑ SOLID WAS <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY to SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECI <br /> 7• 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)east one file type MUST be selected, Fax to(209)469-0138 or mall 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 END 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. <br /> *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 DATt:.. ;.tlMf ,,• <br /> DATE CONFIRMED : . FARC <br /> :C'HON <br /> REVIEWED. .•_ D <br /> . I:TIALS. ..: • : . <br /> YES :.NO <br /> gun�a os F;tIWE—. ATE- <br /> IBM"" <br />