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CAMEIR I A <br /> 1707 935 6649 P.02/02 <br /> DAT �,fEl){E'b�s�i�1.�/�_'r,` <br /> 1 -!i SAN <br /> JO COUNTY <br /> OCT <br /> $ 2003 ENMONMENTAL EEALTH DEPARTMNT <br /> 304 E Weber Ave 3"a Floor Stockton, CA 95205 <br /> -34201Fax: (209)464-0138 Web:www.co.san joaquin.ca.uslehd <br /> F_-NVJR0NMENPRAM& <br /> PFRMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT.�i"_ 1 Q1ts-iT-^t i n; BUMNtSGIACENCY: MLV-�c. Fac,;+�•,n�� � '�c�l,. (o�y <br /> TENTATIVE'APPOINTMENT DATE: Ot—t 4c Dc r Time: ( •OQ <br /> (Pleas@ allow 10 business days from date of appliCatlon Submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> OepaM nt Use Only <br /> FILE ADDRESS UNIT <br /> +. 2 2. ❑ Unit 1 <br /> 5"0- <br /> o ❑ Unit Z <br /> 4. SVW CnLi <br /> e. d ❑ Unit 3 rtv <br /> a sneer <br /> 7. S►est <br /> Unit 4 <br /> �. sheer <br /> t <br /> ENVIRONMENTAL-HEALTH DEPARTMENT FILES <br /> 4CI0UNQEMOUND TANK(USTI CLEANUP SITE(LOP) a NOUSINQ ABATEMENT O SOLID WASTE FACILITY <br /> OTHm CLEANUP SITE(NON-LOP) d f*00 FACILITY 13 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAI-) D DOG KINNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR D CHICKEN RANCH Cl pKe TREATMENT PLANT <br /> T1okW PERMITTED PACILI Y U MOTELIHOTEL C7 Rtl I R TRUCKrcARDICHEM TOILETS <br /> TATrO018ODY PIBt0ING O POOLISPA C1LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the types)of hies fivm the list above by checkini <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(20914L4.0138 or M_2iI to the <br /> address lndi ated 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 OPPIW ion. 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 ne, <br /> application may be submitted when the file is available. <br /> ns <br /> 4. Any file not returned in the same condition as released will be reorganized by 1sHD staff at or exile <br /> of the applicant. Future file reviews by the same applicant may require a$93.0 deposit prior to revie <br /> S. 'TENTATIVE appointment dates must be conf(rmod with EHD staff. <br /> 6. Applications received after 3:00 pm will be proc.pssed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DA'T'E CONFIRMED � PHONE FAX. INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />