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SAN JOAQUIN COUNTY a�� u <br /> 7 04 <br /> OMONWNTAL HEALTH DEPART�iV,T z0 <br /> 304 E Weber Ave Yd Floor Stockton, CA 95205 <br /> APP 0 6 2004 (209)465-3420 Fax: (209)464-0138 Web: www.co.san joaquin ca.US/Ch <br /> [Vi _u I 10 PUBLIC RECORDS RELEASE APPLICATION <br /> P. � ' , <br /> APPIJCP,T17: <br /> ADDRESS; Lam. 04 <br /> PHONE: oZov 15-0 j FACSIMILE: d <br /> Z2_-32� <br /> TENTATIVE' APPOINTMENT DATE: <br /> (Please allow 10 busln(,ss days from date or applicatlan submittal) <br /> CHECK BOX TO EXPEDITE RE -S93.a0 Fl~L-REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE {L a Y <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> t. s— &4NIT L iNt- n. c5lyG� FT e <br /> z saw q 451 a ❑ Unit 1 <br /> 3. slr­l Iq qb S c. <br /> ty <br /> R '4 7! Unit 2 <br /> 5. Sven! $ 14� <br /> s- sd 1Unit 3 <br /> a <br /> r. s�rca19 755a <br /> :Zn:itQ <br /> 8. SUael tl d <br /> CRY <br /> 9. Saeec p �.7i <br /> �o_ saner ❑ Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(l.OP) 0 HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY k SOLID WASTE VEHICLE; <br /> UNDERGROUND TANK(MONITORING)RE..MOVAL) ❑ DOG KENNEL �'DAJRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTF-UHOTEL ❑ PUMFFR TRUCKIYARDICHFM TOILCTS <br /> ❑ TATTOOISODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY M OTHER(PLLASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464_-0.138 or mail to the <br /> address indicated above. -' <br /> 2. FHD 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 (1 d)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 /> 5. 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 PEVTEW DATE <br /> Frio 4a.92"aas <br />