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APR 29 2004 3:35PM Pm 'STONE ENV. 114-414-1166 <br /> . _..__ DAV JUAQIJ1P1 ,vtJNW S-Now <br /> H E I, ,,'' L ENVIRONMENTAL HEALTH)DEPARTMENT <br /> U It <br /> 304 E Weber Ave Std Floor Stockton,CA 95205 <br /> APR 2 9 2( )468-3420 Fax: (209)464-0138 Web:www. . -19uxn.ca.us/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ r?a+�' �O BUSOW-MAOENCY: <br /> ADDRESS: '�i' <br /> PHONE: <br /> FACStIMiI.E: <br /> TKde: <br /> TENTATIVE`APPON MENT DATE: <br /> (Please allow 1a buelfwas dW6"M date of apolcatbn submt4al) <br /> D ,HECK BOX TO EXPEDITE REQUEST-$03_0o FEE"R,pUEST PROCESSED IN 3 BUSINESS DAYS �0 <br /> DATE - <br /> SIGNATURE OF APPLICANT 08mrtmot U"o„N <br /> R <br /> FiLE ADDRESS <br /> Unit 1 <br /> z � �"Z•Z�— �dlti /�i� 1 <br /> a. sr9e� 2_ 2 G.s+r+A�b-�- �` ' ❑ Unit 2 <br /> .. sv.ac �r.�. <br /> tt� Unit <br /> a s+.erc <br /> c <br /> a. Wed ❑ Unit 5 <br /> 9. <br /> �o. succi <br /> c <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> l] HOUSNG ABATEMENT ❑ SOLID WASTE FACILITY <br /> M(UNDERGROUND TANK(UST)CtEANUP SiTE(LOP) a FOOD NG ASAIILITY 0 SOLID WASTE VEHICLE <br /> 12(OTHER CLEANUP SITE(NON-Lop) o F OCi�LI ❑ DAIRY <br /> d UNDERGROUND TANK(MONITORNGIRE MOVAL) Q DW KEN RANCH O PKG TREATMENT PLANT <br /> [�HAZARDOUS WASTE GENERATOR ❑ CHICA EN RAN CI pWpER TRUCKIYARWCHEM TOILETS <br /> TEL <br /> O TIERED PERMITTED FACMIf ❑ POOL,ISPA ❑ LAND USE APPLICATION SITES <br /> 13 TATTOOiBODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> D MEDICAL WASTE FACILITY c checking <br /> I• List up to-ten addresses in the space above. Select the typs(s)of fifes from the list above by <br /> the appropriate box(es). At least one file type MUST be selected. <br /> Fau to( 91 38 or mail to the <br /> q64-01 <br /> address lindicateoAbove. appointment for review will be confirmed <br /> 2. EHD will notify the applicant if any EHD tales exist to appo of application. The files <br /> approximately fire business days but no later than sforBreview. Appoiidays intn'Onbz should be scheduled <br /> will be hell for a maximum of five business days <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. reorganized b EHD staff at expense <br /> q• Any file not returned in the same condition a released will be require a$93.00 deposit prior to review. <br /> of the applicant. Future file reviews by the same applicant t may Q <br /> 5• <br /> *TENTATIVE appointment dates crust be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS <br /> REViEWED YES NO REVIEW DATE <br /> �o+so:-0oa <br /> Own <br />