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11/07/2003 16:12 91686/0430 SECOR PAGE 01/0 <br /> EHU LUU NUMBeK <br /> DATE RECEIVED SAN JOAQUI[N COUNTY �r <br /> A .. , ENVIRONMENTAL HEALTH DEPARTMENT <br /> If irk frf'`��/7`�[ t 304 E Weber Ave 3'a Floor Stockton, CA 95245 <br /> r11[`=-'l{==' 2Q ��4�i8Tt10 Fax: (209)464-0138 Web:www.co.san joaquin.ca us/ehd <br /> NO V 0 7 2u0�03 PUBLIC RECORDS RELEASE APPLICATION <br /> �1�'�/�j.i��t T_My� BUSINESS/AGENCY: o[L i�rf=&ddnwv nj K � <br /> APPLICAp�f� <br /> ADDRESS* .30 -'► vCr �rtE Sv rrrc (aD 1��r1Crb Go�tn�A� y! Q (oar` <br /> PHONE: ql(c Rto 2 '3 FACSIMILE: C_q,�Z 5(p�"cY3o <br /> TENTATIVE*APPOINTMENT DATE: 1 jjt;- _/� Time: 2'tM <br /> (Please allow 10 business days from bate of application submittal) <br /> Q CHECK BOX TO EXPEDITE REQUEST-$93.00 FE -REQ ST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE a/7fo3 <br /> Department use Only <br /> FILE ADDRESS UNIT <br /> 1. - -to ❑ Unit 1 <br /> 2. Street / tJ.A ()J <br /> a. street ON ❑ Unit 2 `�I <br /> 5. Street 'i Lfb :1y at Kr'b it 3 <br /> G. Street I Vyy44A/4o111'J A6*Lf- City 57 L�1 JJ <br /> 7. Street iYZAO E G PR Unit <br /> e. 8tr 3N `t(- arxhJ Agi nw r N <br /> a. st.ee at nit 5 <br /> 10. street C1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING FOOD FACILITY ABATEMENT p"SOLID*SOLID WASTE FACILITY <br /> VEHICLE <br /> 03 OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL 13 DAIRY <br /> A UNDERGROUND TANK(MONITORINGIREMOVAL) <br /> .;V HAZARDOUS WASTE GVNERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY 0 MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOUSPA D LAND USE APPLICATION 3tTES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD 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(10)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 nev <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 reviev <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. TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Ei•1 48.02-008 <br /> 81812003 <br />