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09/16/2003 15: 53 925371PS15 GEOCON - EAST lik PAGE 01/1 <br /> • ENVIRONMENTAMEALTH <br /> DATE RECEIVED Gni PAGE_ ,02 <br /> �' SAN JOAQUIN COUNTY <br /> LN _. 6 r_, ,1. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Wehcr Ave 3',Floor Stockton, CA 95205 <br /> SEP 1 6 2003(209)468-3420 Fax: (209)464-0138 Web:www.Co.san joaquin.caus/ehd I <br /> EIVVIROUENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> P. 1 / t <br /> APPLICANT: BUSINE9G/gGENCY: (ft7� CO C <br /> ADDReas: 3 �' Giv <br /> PHONE: FACSIMILE:_ P ZS` 3Tf <br /> TENTATII/E`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from dsts of appllcatloo subbUttaq <br /> © CHECKDOXTO EXPEDITE REQUEST-$93,00 FEE—REQU PROCESS DJ 0 NESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Deparbbent use Only <br /> J ry/'��. <br /> FILE ADDRESS /,' - UNIT <br /> Y 9�0// �CLr !ESc a Linit 1 <br /> Cf 4; <br /> - <br /> a e ,� O e tlc <br /> s. ,5' Cc r a V it3 <br /> I z vdl f . <br /> ora ec QU 91Unita <br /> ze a <br /> 9. vee / H r a Cl Unit 5 <br /> 0. 8VPRY <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �A UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT E3 SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP Sfff(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> b UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL In DA1RY <br /> Q HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> CI TIERED PERMITTED FACILITY ❑ MOTBUHOTEL ❑ PUMPER TRUGKlYARD/CHEM TOILETS <br /> ❑ TATT00/1300Y PIERCING O POOL/SPA ❑ LAND USE APPLICATION SIT@G <br /> O MEDICAL WASTE FACILITY ❑ OTHER(PLRASK SPECIFY) <br /> 1. List up to ten addresses in the space above, Select the type($)of files from the list above by checking. <br /> the appropriate box(es). At least one file type MUST be selected. Fax t0 (2091484 D139 or mail to the <br /> address indicated ahava. <br /> 2. EHD will notify the applicant H any EHD files exist. An appointment for review will be confirmed <br /> approximately five bufiness 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 an by EHO staff may not be immediately available for review. A new <br /> appllcatlon may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EMD 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. 'MNTATIVE appointment dates must be confirmed with EHD staff, <br /> G. Applications received after 3:00,pm will be processed the next business day. . <br /> CONFIRMED APPOINTMENT PATE TIME <br /> DATE CONFIWEA PHONE . FAX, INITIALS <br /> REVIEWED YES NO - REVIEW DATE: <br /> a <br /> ' 0/MivaO <br />