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09/13/2004 11:53 FAX 209 948. til [a]002/002 <br /> SEP 13 '04 11:191;M CDS—MUD ENGINEERING P,1i1 <br /> DATE RECEIVED END LOG NUMBER <br /> SAN JOAQUIN COUNTY- <br /> ENVIRONMENTAL HEAL-T$DEPARTMENT <br /> 304 E Weber Ave 3r1 Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209) 464-0138 Web;www.co,san-joaquin.ca,us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY. <br /> ADDRESS- <br /> t� <br /> PHONE: -�GD7 73.2— A7,57_ FACSIMILE �Qr f(�3 - A77 <br /> ' <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Pleaee allow 10 businesx days froth date of application tubmittal) <br /> CHECK BOX TO EXPEDITE REQUEST-493.00 F —REQ T PROCESS i BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATI; It Q <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> J. strop, a <br /> �, swot - ElUnit T <br /> n <br /> to ❑ Unit 2 <br /> ,• 8RGe1 <br /> 5, IV— CI <br /> G. street Vey ❑ Unit 3 <br /> T. 4 eeCltr " <br /> ❑. Unit 4 <br /> e, strealeAci. <br /> �. sacci cn <br /> ❑ Unit 5 <br /> 10. Stfeel Ct <br /> 14NVIRONMENTAL HEALTH DEPARTMi=NT FILES <br /> p UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑.SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP-5ITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLIb WASTE VEHICLE <br /> Q UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL O'DAiRY <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑,PKG TREATMENT PLANT <br /> b TIERED PERMITTED FACILITY Cl MOTELiHOTEL 0 PUMPER TRUCKMARDICHEM TOILETS <br /> 4 TATTOOIBODY PIERCING ❑ POOL/SPA r2 LAND USE APPLICATION SITES <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. EHD Will notify the applicant if any EHD 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 fcr 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 EHO 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 /> S. `TENTATIVE appointment elates must be confirmed with EHD staff, <br /> 6. Applications received after 3:00 pm will be processed the next business day, <br /> CONFIRMED APPOINTMENT GATE <br /> DATE CONFIRMED Pai*if Fax Note 7671 Pere g I" 104 pagas� i <br /> REV1EWEb YES NO To-D0 to 'A�{ 1 From A`-, <br /> CoJDepL K lei,nom �e CO' <br /> Ertn se-oz-0oe <br /> Phone 8 Phano# Cl 3 7 p 7 <br /> fl 99�g -od I F * 0137 77 <br /> 09/13/2004 MON 11:16 [TX/RX NO 7273] lj001 <br />