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02/08/2005 15:30 FAX 209 94f "tl Q002 <br /> DATE RECEIVED " <br /> SAN JOAQUlN COUNTY , <br /> C^����D ENviRONMENTALHEALTaDEPAR'�MENT <br /> 304 E Weber Ave 36 Floor Stockton, CA 95205 <br /> (209)468-3420 Fax, (209)464-0138 Web:www.co.saajoaquin.ca.us/ehd I0� <br /> FF3 0 p 2005 <br /> PUBLIC RECORDS RELEASE APPLICA'T'ION <br /> EN '; <br /> wwa .�-• Tx_,eli BUSINESSIAGENCY: iti1?�f�eFcl ' <br /> ADDRESS: O)M2S kW-tLt <br /> PHONE: ..1 n'4S FACSIMILE: Fin!igi -0c ay <br /> TENTATIVE•APPb miimy DATE: Time: <br /> (please allow 10 business days from date of application submlttAQ <br /> CHECK BOX TO EXPEDITE REQUEST-593.00 FEE-REQUEST PROCESSED M 3 BUSINESS DAYS <br /> SIGNATUREOFAPPLIGANT �'�'� �`� ^f� DATE Amy <br /> Depdrhnenl Use Only <br /> FILE ADDRESS UNI . <br /> ,. sbea N, t rtet o p ' Unit 1 <br /> z, Svcs v1 n Nsrdta <br /> s s 1 a o Unit 2 <br /> Unita <br /> a. CW //(J� Unit4 <br /> 7. Slreel j/ <br /> •. shed <br /> !. Shen <br /> ' te. Siad G <br /> 'ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> e <br /> UNDERGROUND TANK(UST)CLEANUP SITE(CAP) 13 HOUSING ABATEMENT 19.Souo WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-COP) O FOOD FACILM O SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK(MONrTORINGIREMOVAL) 11 DOG KENNEL �•DAIRY <br /> !S HAZARDOUS WASTE GENERATOR O AN <br /> CHICKEN RANCH LB-PKG TREATMENT PLANT <br /> EI TIERED PERMrTED FACILITY 0 MOTELMOTEI. O PUMPER TRUCKI'fARDACHEMTOILETS <br /> ❑ TATTOOISODYMERCING 0 POOUSPA 19 LPNO USE ApPLICgnON SREs <br /> 13 MEDICAL WASTE FACILITY n OTHER(PLEASE SPECIFY) <br /> 1, l..tst up to ten addresses in the space above. Select the types)of files from the list above py checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (2091464-013a or mail to the <br /> address indicated above. <br /> 2• EHO 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(40)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. nem <br /> application may be submitted when the file Is available. <br /> 4, Arty file not returned in the same condition as released will he 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 reviev <br /> 5. ^TENTATNE appointment dates must be confined with EHD staff. <br /> 6. Appltcations received after 3:00 pm will be processed the nextbusiness day. <br /> x�<a;.. _ - -,TIME `",:.ic=_;�k*•';..�.;,.:i, ' <br /> �ONF�}2MED..`•i�P,P.�IN7N1EN7�'ATE•'•s:. ' �'. <br /> _ .. ',:•:�r;_`?PHONE ! 'FAX':'`:,`r�ti;�WINFC.IAI=S �_t: <br /> Dg7BGgNFIRMED ' <br /> REVIEWED r: YES NO REVIEW DATE' '..i: '.:: <br /> axe� aoe <br />