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10/01/2004" 11:17 - 2094671118 AGE STOCKTON PAGE '. 01/0 <br /> EHO LOG NUMBER <br /> (�"T,�,,EIv 4 / SAN JOAQUIN COUNT V .,{� ��) <br /> W �md 'V Lb ENVIItoNMENi'AL HEALTH DEPAi2'[TENT :y !I vv"ti l/ <br /> 0 C T 0 1 ZO 304 E Weber Ave 3rd Floor Stockton,CA 95205 A d , <br /> l9)468-3420 Fax: (209)464-0138 Web: www.co.san joaquin.ca.us/ebd �(( l <br /> ENVIR0MIIQ;- " iLff l PUBLIC RECORDS RELEASE APPLICATION ��//vv <br /> PE (1111 TiC'r_P'.11r� <br /> APPLICANT: n SINESSIAGENCY: L� U�Ibh- <br /> ADDRESS: <br /> PHONE OtD7 ,� 7� / Qd�FACSIMILE: Qr _ ,k <br /> TENTATIVE"APPOINTMENT DATE:lel&A0 7 Time: <br /> (Please allow 10 business days from date of application submittal) <br /> -9�GHECK BOX TO EXPEDITE REQ T-Se .00 FEE-REQUEST ROCESSED IN 3 Bu51NESS DAYS <br /> SIGNATURE OF APPLICANT DATE /a Q <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> sit / l'IP cl )YJiu y ,6 El Unit <br /> 2. s� <br /> i. street - : O Unit2 <br /> a <br /> s. s <br /> {. nN ^c L I at � c � <br /> treet Unita '7 <br /> e. smN <br /> > s,ro„ Unit <br /> P Smw CI <br /> 9 Sbeet CI tinit 5 <br /> 0 STAN <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES " <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACT <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY M SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 11 PKO TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY C3 MOTELIHOTEL 13 PUMPER TRUCKIYARD/CHEM TOILETS <br /> O TATTOOIBODY PIERCING 0 POOLSPA ❑ LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY 0 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(209)464-0138 or mall to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant if any EHD Files exlsL 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 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 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. r <br /> CON FIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES N4 REVIEWDATE <br /> P .eAz.ws <br /> aenow <br />