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f' 11/20/200:5 09:59 FAX 4159 041 TREAWIELL & ROLLO 1 <br /> 11/19/2003 14:49 464 $ 001 <br /> DATc RECEivro. ENVIROhIMEN7AL��1 Al 7H' <br /> P4GE 02 <br /> � I �.. $ <br /> EHD cs NuMu;f AV JOAQUIN COUNTx� Jr <br /> 1 � <br /> E11,'IRONMENTAL HEALTH DEPARTMENT <br /> NOV 2 0 2003 304 E Wcbcr Avc Yd Floor Stockton, CA 95205. <br /> (209) 463-3420 Fax: (209),464-013.8 Web: www. <br /> co.san joaquin.ca.us/ehd <br /> ENVIRONMDI i I HLALfj, <br /> PERI'OiT/SERViGFS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ��^I"i�A �iZC BUSINESS/AGENCY: ac(k, <br /> ADDRESS: rSS , 1 05 G 1 <br /> PHONE: E try C� FACSIMILE: <br /> f, <br /> TENTATIVE"APPOINTMENT DATE: �r f7 03 Time: <br /> (Please allow id business days'rrom date of appllCatlon submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-50:00A <br /> 59 :00E qU ,T PROCFSSEQ IN,3 BUSINESS DAYS <br /> SIGNATURE OF.APPLICANT. ' '. .DATE, ' <br /> Department Use ONv <br /> UNIT L ' <br /> 1, Street � Cq - � i- . <br /> 2. sveel <br /> 4. sirrer V Unit 2 <br /> Gr <br /> S. $1rC 1 <br /> city <br /> B. street - al C V_ <br /> SveN Gt Unit' <br /> e Strea! �! ' <br /> H. SVael CR <br /> Unit 5 <br /> to. Street <br /> COY .. . <br /> ENVIRONMENTAL HEALTH 0EPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP 5Mt,(LOP)' ❑ HOUSING AbAftMENT _ C] SOLI}WASTE FACILITY: r <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY' ❑ -SOLID WASTE VEIMCL.E <br /> UNDERGROUND TANK(MONITORING(REMOVAL) ❑ DOG KENNEL I7 DAIRY I r <br /> G HAZARDOUS WASTE GENERATOR a CHICKEN RANCH CO PKG TRt ATTVIENT PLANT <br /> 0 TIERED PERMnITEDFACILITY O MOTEL/HOTEL ❑ PUMPER TIkOCKrYAROICHEMTOILETS <br /> 0 TATTOOIBODY PIERCING ❑ POOLISPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY Cl 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 !20911454-0138 or mail to the 5 <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. Thi 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 8HD staff may not be lmri 6diately 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 he reorganized bjiliD staff at the expense <br /> of the applicant. Future file revie>Irs by the Same applicant may require a.$93.00 oitl owe e5. TENTATIVE appointment dates must be confarrrted•'with EHO staff. ,6. Applications received after 3:00 pin will be processed the next€�usiness day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED- PHONE FAX INITIA.LS <br /> REVIEWED YES NO REVIEW DATE <br /> ENO 4 a•olaot <br /> - <br /> ryll <br />