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04/15/2004 15:15 2094671-11R AGE STOCKTON PAGE 01/17_ <br /> DATE RECEIV�� =:�' EHD LOG NUMBER <br /> SAN JOAQVV COUNTY <br /> APR 1 5 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> I h#0- 468.3420 Fax: (209) 464-0138 Web: «-w,,Y,co.san joaquin.ca,us/ehd 7 -3 <br /> ;E1!ICES <br /> PUBLIC RECORDS RELEASE APPLICATION � <br /> APPLICANT: Smatifie o BUSINESS/AGENCY: l t(JlX�I'IC+Q auiron M L <br /> ADDRESS: //��O h u) a" <br /> OP 95 <br /> n� <br /> PHONE: 670 Q. y67 �Du(p FACSIMILE: C�7��j• <br /> TENTATIVE*APPOINTMENT DATE: Imo: •• Qr ea�1�er <br /> �F acre <br /> (Ploase allow 10 busrnass days from date of application submfttal) <br /> n � <br /> Mae <br /> CHECK BOX TO EXPEDITE REQ UE OST-593.00 FEE—REACE SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPL.ICAN DAT <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> AD11 D El unit 1 <br /> z s��, a h !/ <br /> Chy <br /> Aw <br /> I. Stroe! n'1Q.n \Jj *'...'J SSV V 0 Unit2 <br /> s. sueel C41ty <br /> 6 trod �l 5 fi V <br /> stmei <br /> Sl <br /> eel /010 Unit 4 <br /> 9. SV <br /> 9 Strad lhuli <br /> D <br /> city ❑ Unit 5 <br /> CIN / <br /> pF <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �^a <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELJHOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING O POOLISPA ❑ 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 feast one file type MUST be selected. Fax to(209)464-0138 or mall to the <br /> address Indicated above. <br /> 2• EHD will notify the applicant If any EHD files exist. An appointment for review WIN 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 expense <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 <br /> m will be processed the next business day. <br /> p <br /> CONFIRMED APPOINTME=NT DATE. <br /> TIME <br /> DATE CONFIRMED PHONE . FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE . .. . <br /> EHD 48-G2-006 <br /> lt8120QJ <br />