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91E48-6688 P- 1 <br /> Oct 29 04 09: 58a F <br /> Environmental <br /> Group EHpLOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ROVMENTAL HEALTH DEPARTMENT <br /> 3 Weber Ave 3d Floor Stockton,CA 95205 - <br /> - -342 ax: (2.99)464-0.138.Web www-co San 3oaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> _BUSINESS IAGENCY: <br /> L1CAN ' <br /> FACSIMILE: r <br /> Zl'o - <br /> ,n"te: - <br /> TENTATIVE"APPOINTMENT DATE: 08 8 160-t. <br /> (Please allow 10 business days kora dale of application submittal) <br /> la CHECK BOX TO EXPEDITE REQUEST-$93.90 FEE- U T PROCESSED IN 3 BUSINESS DAYS !y 0 <br /> SIGNATURE OF APPLICANT Department Use Only <br /> UNIT <br /> FILE ADDRESS <br /> GSC6 O .3 U ❑ Unit S <br /> ,. stretl Ci <br /> z. SIM[ • J lti�=. ❑ Unit 2 <br /> d C01, <br /> . <br /> 3. Weet <br /> 4. street .3LQit 3 1, <br /> 5. Street •`A Y�:., ,,}v1 .�?GE•'� <br /> s. street Unit <br /> �. r,,. <br /> 7. street � Cl <br /> � L <br /> e. Straet u � - nit 5 <br /> U <br /> w. street 21 S `ycku.� <br /> }Z'L �ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> !9 UNDERGROUND TANK{UST}CLEANUP SITE{LOP) iD FOOD FACILITY M SOLID WASTE vEHICLE <br /> W OTHER CLEANUP SITE(NON-LOP) EI DOG KENNEL ElDAIRY <br /> In UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> a HAZARDOUS WASTE GENERATOR p MOTELIHOTEL CI PUMPER TRUCKIYARDICHEM TOILETS <br /> F TIERED PERMITTED FACILITY '❑ POOLISPA ❑ LAND USE APPLICATION S[TES <br /> ❑ TATTOO[BODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> }, List up to ten addresses in the space above. Select the type(S)of files from the list above by checking <br /> the appropriate b addresses <br /> At least one file type MUST be selected. Fax to 209 464-0138 or mail to the <br /> address indicyted abpop e. y ointment for review will be confirmed <br /> 2. EHD will notify thea licant if an EHD files exist. An app Ircation. The files <br /> approximately five business days but no later than ten (10) days after receipt of app <br /> will be held for maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> orked on by EHD staff may not be immediately available for review. Anew <br /> 3. A file that is actively being w <br /> application may be submitted when the file is available. <br /> as be reorganized bypP <br /> sta <br /> at the expense <br /> same <br /> 4. Any file not returned in the same condltthe a released licantl may require a$93 OOydep sft prior to review.w. <br /> of the applicant. Future file reviews by <br /> 5. "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 DATE = <br /> TIME <br /> DATE CONFIRMED <br /> PHONE . FAX ' INITIALS <br /> REVIEWED YES NO <br /> REVIEW DATE <br /> EHI]4842.006 <br /> erana0s <br /> i <br />