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\ / Mar- 18-04 11 : 27A P <br /> VmordVEL) FHT)LNIJME, M <br /> I U���/ IE��I, SAN JOAQUIN C:OUNTV <br /> f� ENVIRONMENTAL 11EALTH DEPARTMENT <br /> MAR 18 2 ,fiQ_(Tdd 304 FWeber Ave 3'' 1�Innr Stockton, CA 9,5205 <br /> 9) 468-1,120 Fax: (209)/164-0139 Web: www.co.san-ioaquin.ca.us/c}td e7 37 <br /> ENVIROIWILWT HEALTH <br /> PEWiT! R PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: lrrU'( BfU�SINFSS/AGENCY: <br /> ADDRESS: /c J 4w CSS L-1�1C=u.L �— �'. oy T� ,C A ! 3 . . -- <br /> PHONE: FACSIMILE: :JT� Q <br /> -- --. <br /> �J <br /> TENTATIVE"APPOINTMENT DATE: 1/" � &I l Time: L) <br /> (Please allow 10 bus days from date f application submittal) I!A <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 QU E ST/PR SSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> LtuUarlrncrnl Use Only <br /> FILE YADDRESS U 7 UNIT <br /> tJaw <br /> ❑ Unit <br /> 7 r <br /> A,1 _,Oily V <br /> 3 SVert Aodl wey Ol ---- `� L1 Unit Z a� a-(� <br /> ,l—t <br /> One C <br /> r'�r <br /> Un � <br /> sl Unit 4 <br /> R tilroat l:il - _ — <br /> ;Woo <br /> ❑ Unit 5 <br /> 10. tiVonf tt�r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES s <br /> U ERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A13ATEMENT ❑ SOLID WASTE PACI Y a3Y. <br /> ❑ THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UIttSERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING El POOL/SPA ❑ LAND USE APPLICATION SITES <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(209) 464-0138 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 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 expanse <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 /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> bi <br /> b <br /> CONFIRMED APPOINTMENT DATE TIME L <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48-07-008 - ---- �----•-- <br /> aierzoo3 <br />