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MAY. 18. 2004— 2: 08PM "`1NTGOMERY WATSON NO. 923EHDLP (UMBER <br /> DATE RECEIVED I� • SAN JOAQULN COUNTY <br /> D � I=Ii�'J � ENVTRONMENTALHEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton CA 95205 <br /> MAY 18 ZQ69) 468-3420 Fax; (209)464-0138 Web; www.cO.San joaquin.ca.us/ehd I <br /> IV',ji),NN1ENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: v BUSINESSIAGENCY: V" <br /> ADDRESS; L5 <br /> PHONE;al61 FACSIMILE: �69y <br /> TENTATIVE"APPOINTMENT DATE: <br /> Time: <br /> (Please allow 40 business days from date of applimt on submittal) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$93 00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS O <br /> PATE <br /> SIGNATLJREOFAPPLICANT pepartrn ntUseOnly <br /> UNIT <br /> FILE ADDRESS <br /> Unit <br /> 11 s at �`�� e �boc� o✓i a ❑ <br /> G <br /> z s S L Unit 2 <br /> cn d <br /> a. s 000 <br /> 4. <br /> s. s ' a d <br /> G. wear Z ° Unit <br /> 1. ebeet I_700 G <br /> cityd <br /> a. sraat { Unit 5 <br /> 3 t O N M <br /> 9. 5 et l I Gl 9 <br /> o. sveet <br /> 2`t 2 'n a <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> $( UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOUD WASTE VEHICLE <br /> O OTHER CLEANUP SITE(NON-LOP) Cl DOG KENNEL ❑' DAIRY <br /> yIX�( UNDERGROUND TANK(MONITORINGIREMOVAL) CI CHICKEN RANCH ❑ pKG TREATMENT PLANT <br /> j9_HAZARDOUS WASTE GENERATOR CI MOCKEN RAL ❑ PUMpERTRUCKIYARD/CHEM TOILETS <br /> Cl TIERED PERMITTED FACILITY CIPOOLISPA ❑ LAND USE APPLICATION SITES <br /> C1 TATTOOIBODY PIERCING ❑ OTHER(PLEASE SPECIF'� <br /> ❑ MEDICAL WASTE FACILITY <br /> 1, List up to ten addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate dresses At least one file type MUST be Selected. Fax to (20_9]464-0138 or mail to the <br /> address indicated above. ointment for review will be confirmed <br /> 2. END will notify the applicant if any END files exist. An appointment days after receipt of application. The files <br /> approximately five business days but no later than ten( ) y ointments should be scheduled <br /> will be held for a maximum of five business days for review. APP <br /> accordingly, available for review. A nem <br /> 3. A file that is actively being worked on by EHP staff may not be immediately <br /> application may be submitted when the file IS available. <br /> 4. Any file not returned in the same condition as released�wnt may reqube ire a$".00 deposit prior to-expense <br /> em <br /> of the applicant. Future file reviews by the same app ' <br /> 5. *TENTATIVE appointment dates must b® con o essed the®xt business day. <br /> 6, Applications received after 3:00 pm will be p <br /> �� IR��?' RPQINTAII�fst'f�AtT� <'rs `.�..;,,: �.. .NN .:• ye .� .. �'"' ',,..�•. <br /> .t .y .tM, y�x."T�.—.�. .v ��e- a^ .Yd pi.t�• ' �.r."''1��7'{AL•5.�'�., . .. <br /> r {, tr''�'•' 'pl{pJ+)E:;,.?`. �cr'AX.!' ;2+.,�: .p s. ,rr---�•`�- A�i! <br /> DA E GONpIRNfE(1' <br /> RI VIEWDD ' ' YES N�' <br /> EHn as 406 <br /> 0/B20aS <br />