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-Oct:' 14 2004 1 : 18PM F 'drrie't"'Fit .Law <br /> (91r" `635=3530 P ,. <br /> -16114/2004 JA— ,3;� 4640138 ENVIRONMENTAL HEAL-FH PAGE 01 <br /> - 1, } esnv Lw INUMOen <br /> DATERECENED (�,V, SAN JOAQUIN COUNTY <br /> ENv RONMENTAL HEALTH DEPARTMENT _ <br /> OCT 1 2004 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> rave'; 1_'r'v ;(gp,- -''468-3420 Fax: (209)464-4138 Web:WWW_Co.san joaquin.ca.us/chd O <br /> PUBLIC RECORDS RELEASE AppLICATION <br /> S 9USMESVA4'.ENCY: <br /> 4 APPLICANT: <br /> ADDRESS; <br /> t-PHONE: !l�O! 7'-Jn 3 3 —FACSIMILE: <br /> T1me: <br /> TENTATIVE-APPOINTMENT DATE; <br /> (P1 <br /> 9 <br /> 3 <br /> 3e allow 10 bu6)nOts days from date of application submittal) <br /> ❑ CHECK BOX TO EXPEOITE REQUEST•s� FEE-R Ea1JE3tPROCESBE0 IN.10 U S IN M DAYS <br /> _ DATE <br /> SIGNATURE OF APPLICANT Department usa only <br /> UN1T <br /> FH E ADDRESS <br /> S ❑ unit 1 <br /> e <br /> 1. SNee� G <br /> ,. >Itm� ❑ Unit 2 <br /> 3, st.ee t <br /> i D <br /> y, aveN a <br /> !. saecr Ci Iknit 4 <br /> 1. Hnor G <br /> SRN c <br /> 11. sar_1 <br /> 1 D. Sl,7et <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> D HOUSING ARAT£MCNT !PKG <br /> SOLID WASTE FACILITY <br /> NDERGROUND TANK(UST)CLEANUP SITE IL�1 ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL DAIRY <br /> a UNDERGROUND TANK(MONUr <br /> ITORINGfREMOVAL) ❑ CHICKEN RANCH TREATMENT PLANT <br /> d HAZJlRDOUS WASTE GENERATOR ❑ M0TEI/NOTEL PUMPERE APPLICATION SrfiA TOILETS <br /> D TIERED PERMIT ED FACILITY DpoOLISPALAND USE APPLtGATION 5(T>E$ <br /> O TATTOOISODY PIERCING D OTHER(PLEASE 5PI IFY) <br /> CJ MEDICALwASTE FACILITY <br /> 1. List up to ten addresses In the space above- Select the selected, <br /> of files from the Ilst above by checking <br /> bax(es)- At least one file type MUST be selected. 'ax to 209 464 0139 or mail_o the <br /> Vne appropriatenRrmed <br /> W== <br /> ! dice s at>c�YL D files exist, An appointment for review WIII be co <br /> EHD will notify the applicant EF any Etl ) y 11cat.o a The files <br /> 2. ointments should xheduled <br /> approximately five business da' <br /> but n0 later than ten(10 days atter rQceipt o app <br /> will be held for a maximum of five business days for review. App <br /> accordingly. <br /> 3 q hie that Is activ4fy being worked on <br /> �e�ells available. <br /> not be immediately available for review- <br /> new <br /> application may be submittedr to review. <br /> ,� Any fits not returned In the same condition <br /> as sem released tlnti may squire a$93.o Hdeposiitapabe topers <br /> of the applicant. Future file review by <br /> the*TENTATIVE appolntment dates must <br /> 5. be confirmed with EHD staff. <br /> 5. Applications received atter 3.00 pm will be processed the next bustnegt day. <br /> TIME <br /> CoNpIRMED APPOIINTMENT DATE PHONE FAX INITIALS —r <br /> DATE CONFIRMED ��- REVIEW DATE <br /> YES NO <br /> REVIEWED <br /> ..•02-00., <br />