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12/03/2004 10:28 4640138 ENVIRONMENTAL HEALTH PAGE 02 <br /> DATE RECENED - <br /> �a./ SAN JOAQUIN CouNTX � END LOG NUM$ER <br /> ENVIRONMENTAL HEALTH DEPARTN,[ENT <br /> 304 E Weber Ave 3'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: ' e-, A a BUSINESSIAGENCY: �l� �K u ��r.+" <br /> ADDRESS <br /> PRONE: Z� Z e FACSIMILE: e .Z - Z" -Lc/L/ <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> o <br /> (Please allow 10 business days from date of application sabmittai) <br /> P�SHECK BOX TO EXPEDITE REQU -$93.00 PEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURti OF APPLICANT DATE flxj <br /> t Use Only <br /> FILE ADDRESS UNIT <br /> z, easel 2- L;,i ❑ Unit 1 <br /> s. 55S >zv� yy,ivl HC'14- r—_ ee / F 1 �` <br /> s. saver 2 Q C r C t( ❑ Unit 2 <br /> N <br /> 5. StreetMY 00, <br /> S. sty Unit 3 <br /> s. savNcily, . <br /> e. svtset ,t � Unit 4 <br /> 9, stsec Unit 5 <br /> 10. Scoot :� . <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �1 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) D FOOD FACILITY O SOLID WASTE VEHICLE <br /> PL UNDERGROUND TANK(MONITOFUNGtREMOVAL) ❑ DOG KENNEL O DAIRY <br /> M HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMrr MD FACILITY ❑ MOTEL/HOTEL Q PUMPER T'RUCKtYARDICHEM TOILM <br /> 0 TATTOOtB6DY PIERCING O POOL13PA Ci LAND USE APPLICATION SITES <br /> ❑ MEDICAL.WASTE FACILITY O 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(249)464-0138 or mail to the <br /> address Indicated above. <br /> 2. EHD Will notify the applicant If any END 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 maximum of five-business days for revlew. 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 /> S. '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 /> CONFIFWE'D:iA.PJ!OINTMENT:PALE TIME <br /> :DAt COt�F112N1 D. _ "PHONE . . FAX. •i jij`ALS <br /> AtVIEVYED YE3 NO REVIEW DATE... <br /> ' END t8-0Z-006 - _ <br /> elU20C3 <br />