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01/14/2005 09:46 FAX 209 948C f Z 002/002 <br /> RECE;IVEl3 <br /> SAN JOAQUIN COUNTY <br /> ENMOKMNTAL HEALT_HDFPARTraENT �- <br /> 304 E Webcr Ave 3`� Floor Stockton,CA 95205 <br /> 1 4 46$-3420 Fax: (209) 464-0138 Web: <br /> 07S <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION ,' <br /> APPUCAN ' BUSINESSrAGEHCY. <br /> ADDREss• '�. 2. lM !r•� `"� _ <br /> Q <br /> PHONE: - FACSIM' ILE: a' 4 �flFoai' <br /> TENTATK*APPOINTMENT DATE: 'S <br /> (13k se allow 10 business days from data of apptlaadan submith d) <br /> -� CHECK BOX TO EXPEDFTE REQUEST-$9tI,oa F££,REQUEST PROCESSED IN 3 BUSINESS DAn <br /> SIGNATURE QF APPLICANT _.. . DATE <br /> Deaartrnent Use Only <br /> FILE ADDRESS UNIT <br /> �. sv Y'� a p unit 1 <br /> a. sv r- <br /> Alva u r Unit 2 1rJ,\Q <br /> i. suit v <br /> S. soca <br /> s s 1� inn a 9 7 , d� <br /> r. sreet v a u "'M knit 4 , <br /> 4 <br /> e- sues <br /> 9 sum ❑ Unit 5 <br /> City <br /> �A• <br /> -ENVIRONMENTAL HEALTH 0EPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP.5FM(LOP) ElHOUSING ABATEMENT rrY <br /> OTHER CLEANUP SrM(NON4-OP) d FOOD FACILnY ❑ SOUC WASTE VEHICLE I <br /> I& UNDERGROUND TANK(MONITOWNGlREMOVAL) ❑ DOG KENNEL 19-DAIRY <br /> a HAZARDGUS WASTE GENERATOR ElCHICKI=N RANCH S tPKG TFf EATMENT PLANE <br /> C} TIERED PERMITTED FAC1LfrY ❑ MOTELIHO'TF-L El PUMPER TRUCKIYARD1CH5M TOILETs <br /> 13TATTOVSOOY PIERCING ❑ POOLJSPA [� LAND U9>=AJ'PL1CATjON SITES <br /> ❑ MEDICAL WASTE FACILITY d OTdiER(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 appragriate 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. .1 EHO 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 for a rrtaxlmum 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 fife not returned in the same condition as released will be reorganized by€HD staff atthe expense <br /> of the applicant.' Future file reviews by the same applicant may require a$93.00 deposit prior to review <br /> 5. 'TE14TATiVE appointment dates must be confirmed with EHp staff. <br /> 6. Applications received after 3.00 pm will,be processed the next business day. <br /> 'CQ�1FMo 14T q: <br /> M - "•`I IME <br /> -' A7E-CCaNF]RPiEij ."."'.'}'Ftib1`dt< - FAXCCIAI $ <br /> ;� <br /> RV,IEWED YES NO REVIEW DATE.' ' <br /> ' EHa�a.az-0as <br />