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- bl1<WUb NU CALIF PAGE 01/0 <br /> "R GE,V t!HU wU NUMMtK <br /> W ;�! SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> AUG 10 2004 304 E Weber Ave 3rd Floor Stockton, CA 95205 lqqT <br /> (209)468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin_ca.us/ehd <br /> ENVIRONMENT HEALTH <br /> PERWIMSE/RVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:- Y<IR-AN NAA.RR.Pr3V BUSINESS/AGENCY: 6TkATU.5 ENgl"NNENTftt `l Mc. <br /> aoDRess((: 3330 CPrrn6lGVIJ Pq y briyE Surae 4550 / CMneurl PHM- CA- '15,682. <br /> PHONE:S530, 6Tb Gen- FACSIMILE:_ (G3 o) 6�b 6o 05 <br /> TENTATIVE'APPOINTMENT DATE:O s jI x-10¢ Time: 0 S*00 k fA <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST•$ 3�00 FEE-('REQUEST PROCESSED IN 3 BUSINESS DAYS 1 <br /> SIGNATURE OF APPLICANT ^to A+/ OUyAa DATE d 5, 04�_ <br /> Depanment Use Only FILE ADDRESS UNIT <br /> t, So-eot x}05 WUNTiCy LW E cit S GGPV IJ <br /> z so-aai Q Unit 1 <br /> ci <br /> 3. s� z_0y <br /> D <br /> 4, s,,,, ❑ Unit 2 �. <br /> D <br /> ca <br /> s. sireei <br /> gU <br /> nit 3 <br /> c <br /> Stm� <br /> cay <br /> s swel nit4 <br /> c' <br /> tc. sig ❑ Units <br /> cn <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 21UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY - <br /> Z"OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> �'VNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 0-'AA7ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOCISODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITE$ <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• END will notify the applicant if any END 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 END 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 END 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 END staff, <br /> 6. Applications received after 3:00 pm will be processed the next business day. ro <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 4&02-006 <br /> B/Ef200] <br />