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11 003 <br /> 1%'F'1'28/2004 13:24 FAX 209 948 ,1 c�+�w••�•^��` <br /> DATr.MCMVED fir/ SAN JOAQU1N COUNTY <br /> EN'VMONMNTAL HEALTH pEPARTN MNT <br /> 304,E Weber Ave 3 Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:www.comn-joaqummuslehd <br /> PUBLIC RECORDS RELEASE APPLICAIION <br /> ItC6111%. BUSINESSMOEIICY: <br /> ADDRESS: <br /> PHONE: � Fa.s- �4 y"d�C1[oo?f <br /> TENTATIVAPPOW MENT DATE:_ IT��p`'I Tm»: <br /> - <br /> E' <br /> (Please Allow t0 busines days frau date of application submittal) <br /> ❑ CHECK BOX TO p(PMM RWMT_S93.00 FEE—REQUEST PEEOCESSE.O*13 BUSMESS DAYS <br /> SIGNATURE OF APPLICANT ,_ �` DATE l <br /> DepartmeM Use OnIY <br /> UNIT <br /> \ <br /> FILE! ADDRE'. Lip Unit <br /> AIN <br /> S. <br /> s . . <br /> a 1 Unit <br /> r <br /> IL wlftd ❑ Unit 5 <br /> ENVIRONMENTAL HEALTH VF_pARWENT FILES <br /> SM(LOP) 0 HOUSING ABATEMENT i sOLJO WATTS PACILTTY <br /> �,UNDERGROUTA TANK(UST)CLEANUP 0 FOOD FApUTY 0 SOIJO WASTE VE UCLE <br /> 19 OTNBt CLEANUP SITE(NO"LCA MOVAL) O DOG KENNEL O� DAIRY <br /> IN MMGROUND TANK(MOWTORINME 0 CHICKEN RANCH el PKQ TMATMENT PLANT <br /> J4 HAZARDOUS WASTE GENERATOR0 MOTELhiOTEI 0 PUMPERTRUCKIYARD!' WM TOILETS <br /> FAiCILM 0 POOLISPA LAND USE APPLICATION SITES <br /> O TATT0O8OOY PIERCING 0 OAR(PLEASE SPECIFIC <br /> O N{EW_*L WASTE FAC><M <br /> �. <br /> List up to ten Viddresses in the space above. Select the types)of flies from the list aboYe achoc�� <br /> ii <br /> Li <br /> the appr�opriatebox(es)• <br /> At least one fife type MUST be selected. Fax to( as4-o138�_ <br /> address indite above_ appointment for review will be confirmed <br /> 2. EHD will notify the applicaint if any EHD files exist An(pp'o i of application. The files <br /> = ap be hekltely fiye business days but no later than for maim m odays <br /> f rive business days forQreview, Appointmentsafter should be scheduled <br /> will <br /> accordingly. y A new <br /> 3- Afile that is octh►ely being worked on by EHD staff may not be immediately available for review- <br /> appli+cation may be submitted when the file is available. anized b EHD staff at the expense <br /> 4. Any fila not returned in the same condition as released will be reorg y p review <br /> Of the applicant. Future file reviews by the same applicant may require a X93,00 deposit flor to <br /> S. 'TENTATNE appointment dates must be coririnnled with EHD staff. <br /> g, Applications received after 3:00 pm will be processed the next business day. <br /> TIME <br /> ,(s�NF, M 1�?INTMpdbATE ;`r <br /> - �` ..AL <br /> . ... •, .. „ - '�.PHONe•. FAX';. •; �-. •,,.. •. . . . I <br /> REVIEW DATE' <br /> •$E5 NO .1 <br /> �tE1/IENiED ''' . <br /> mr"03 <br />