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'11/03;.2003 11: 19 4640138 ENVIRONMENTAL HEA <br /> PAGE O1 <br /> DATE RECEIVED t=nu I_uo ivumocrt <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3" Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209) 464-0138 Web: v^vw.co.san-joaquin.ca-us/ehd <br /> //�� I PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: .411, 4k 1,e YOZ/OD BUSINESS/AGENCY::7`✓ O0/ /!JG O✓1 ��/l <br /> ADDRESS: 25920 _A14141� LIC 51`aG�M n I G-7_ 9SAO6 <br /> II PHONE: DQ; 93i- 7 _FACSIMILE ri(1J7� / meg-J77 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> 17 CHECK BOX TO EXPEDITE REQUEST-S93AW FEE- UEST PROCE N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE l73 <br /> Department Use Only <br /> r FILE ADDRESS UNIT <br /> 1 1 Slreel <br /> 7 r• oCl� o ❑ Unit 1 <br /> 2. Slreel CI <br /> 3. Slreel CI ❑ Unit 2 <br /> n. Slreel 01 <br /> f 5, 5veat <br /> city ❑ Unit 3 <br /> dj/( 5. Street Clr <br /> sucec CI Unit 4 <br /> V a <br /> e. sueei <br /> s. syset ory ❑ Unit 5 <br /> 1a. stmet Civ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HA7ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL C PUMPER TRUCKlYARO/CHEM TOILETS <br /> In TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> he <br /> om the list above by <br /> 1 List Up to ten addresses thea appropriate box(es). inthe <br /> least one fiace le typove.e MUSTelect tbe selected f Fax stor(209) 464-0138 or mail toc the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EMD 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 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 pm will be processed the next business day. — <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> e/d12003 <br />