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01/14/2005 09:46 FAX 209 9480 07002/002 <br /> s RECEIVED <br /> SAN JOAQu1N COUNTY <br /> 4CENSO ENVIRONMENTAL HEALTH REPAPTNIENT - 9607S <br /> 304E Weber Ave 3"d Floor Stockton, CA 95205 <br /> `4 1 OPRP 468-3420 Fax: (209) 464-0138 Web: �riv%v.co.szn-joaquiumu-s/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICArHON <br /> APPUCAN1-7 BUSINESSIAGENCY: woke-irr <br /> ADDRESS- !1E �t5�;2y� <br /> PHONE: pACSIMILE: 0� 1�1 'DEoOZv <br /> TENTATIVE`APPOINTMENT DATE: Time, Ia;oo <br /> (Please allow 10 business drys from dato of application submittal) <br /> CHECK 80X TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED 1N 3 RU$INE53 DAYS <br /> SIGNATURE OF APPLICANT ,r� j � DATE I� t7 <br /> 0110 hent Use Only <br /> FILE ADDRESS UNrr <br /> ,- sU IA aty $ Unit 1 <br /> Uty <br /> a. svr4 r 6�Ya n� Unit 2 <br /> .. sCA . <br /> a I� <br /> s. s+�c tv i no vc a i f c 7 lti� <br /> 7- sveet v a " t. n1 Unit 4 <br /> City e. SUeee <br /> 9, SUee{ ❑ Unit 5 <br /> • �o. saw a <br /> ENVIRONMENTAL_HEALTH DEPARTMENT FIDS <br /> UNDERGROUND TANK(UST)CLEANUP S"(LOP) ❑ HOUSING ABATEMENT uL..SOLID WAS ILny <br /> OTHER CLEANUP STTE(NON-LOP) d 1"000 FACILfTY ❑ SOUO WASTE VEHICLE <br /> C9- UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL fg- DAIRY <br /> ffi HAZARDOUS WASTE GENERATOR ❑ CI-HCKEN RANCH C91-PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTHD FACILRY ❑ MOTEL/NOTEL o PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOM00Y PIERCING O POOLJSPA Ca LAND USE APPLICATION srTES <br /> ❑ MEDICAL WASTE FACILTTY 11 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST he selected. Fax to 209 464-0138 or mail to the <br /> address.indicated above- <br /> 2. EHO will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> approximately five husiness 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 /> rF cw...,, •, TIME '; a:. .:,, <br /> -C0I451gM D APl?O1NTMENT D'AT�' ;r s..r� �:•-": w'•:,v._ 1..':':':-<< ��-: <br /> •1`PIiONF 7 •FAX, -,;,:: '�1N[11AL <br /> ,DDI-E.CaNFIR1V EQ :.� <br /> REVIEWED YES NO REVIEW DATE; <br /> EHD 4a-02-0U6 ' <br />