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��•�� ���� Hur- aIUl.RIU11 rAUL nlIC <br /> 17 r <br /> �DSA?1 RECEyVEb,�I l� EHD LOG NUMBER <br /> SAN JoA,gUtN COUNTY <br /> APR 15 2004 ENWRONMEN)<'AL HEAL')<u DEPAR'T'MENT <br /> 304 E Weber Ave 3d Floor Stockton,CA 95205 <br /> -1'111T H#0 468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.uS/ehd <br /> SERVICES z <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT: BUSINESS/AGENCY: atwinIC&Q0 <br /> ' III�I IZ'{LOIL <br /> ADDRESS: . /�C317 SA <br /> W ������/�� j-9 J <br /> PHONE: 070 Q. V&7 iDa FACSIMILE:. `1 f� / ~/" <br /> ar e�rnl�e�^ <br /> TENTATIVE"APPOINTMENT DATE: (_. (d,ZVL�r� me: • <br /> f� <br /> �� u . <br /> (Please allow 10 business days from date of application submittal) <br /> 3' CHECK BOX TO EXPEDITE REQ ST-$93.00 FEE—REQUE OCE SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN DATE 7 CI <br /> Department Use Only <br /> FILE ADDRESS NIT <br /> �D <br /> finite PW' Unit 1 <br /> z. s - Hard h U - a <br /> 4. 51L <br /> S r�aln •m <br /> 5. 3SMAInyiONDAD �d <br /> ORO Unit 3 <br /> �. 6m+ac <br /> e. srm Ckv <br /> 4 <br /> 9. Strad cityUnit <br /> Unit 5 <br /> 10. Shea O / <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) C7 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY t <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEIJHOTEL O PUMPER TRUCKIYARD/CII1., <br /> ❑ TATTOO/BOOY PIERCING G POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> T. List up to ten addresses in the space above. Select the type(s)of files from the Ilst 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 /> z• EHD will notify the applicant If any EHD flies 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 expense <br /> of the applicant. Future File reviews by the same applicant may require a$93.00 deposit prior to review <br /> 6. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6• Applications received after 3:00 pm will be processed the next business day. RUSH <br /> CONFIRMW APPOINTMENT bATt. . TlAAE: ' . • <br /> . <br /> DATE CONFIRMED PHONE.: : . . FAX INITIALS LL_ <br /> REVFEWED YES... NO. ... REVIEW DATE " " <br /> EHD 46-92-M '- <br /> IM2003 <br />