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12/28/2003 . 18:38 9252"(;121 AEI CONSULTANTc- (SF) EHD OAGNUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY U <br /> 1 I i ENVIROIq v NTAL flEALTa DEYAxTMENr <br /> - 304 E Weber Ave 3r4 Floor Stockton CA 95205 <br /> D r C 3 ge )468-3420 Fax:'(209)464.0138 Web:w�vw.co.san-joagvin.ca-us/ehd <br /> 1lr;�aCiNMcNT r aLT i PUBLIC RECORDS RELEASE APPLICATION <br /> _ .�� <br /> APPLICANT: Yl BUSINESSIAGENCY: <br /> ADDRESS: <br /> icto a1o�✓ C �l IJl <br /> C7 ll5 FACSIMILE: �G^J <br /> PHONE: <br /> TENTATIVE*APPOINTMENT DATE:5m <br /> Time: <br /> (PleaSa allow 110 business days from dale Of 2pPUMIJ00 subm'dtat) <br /> CHECK BOX TO EXPEDTM REQUEST p3.00 F E—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> fir_ DATE <br /> SIGNATURE OF APPLICANTDepartment use OnN j <br /> is <br /> UNIT <br /> FILE ADDRESS <br /> C1 0 Unit 1 <br /> At <br /> Unit 2 <br /> a 2 WI <br /> 4: Srex `t N. D tiVA. a Unit 3 <br /> 5. b'roeel P Q <br /> e. Sveet I 1 Unit <br /> s et GI <br /> e. sa 7a 1 2 I n <br /> 9. SUee C <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ( UNDERGROUND TANK(11371 CLEANUP SITE(LOP) L] HOUSING ABATEMENT 3k SOLID WASTE FACILITY <br /> ❑ FOOD FACILITY CI SOLID WASTE VEHICLE <br /> M OTHER CLEANUP SITE(NON-LOP) ! c3 DOG KENNEL ❑ DAIRY <br /> M UNDERGROUND TANK(MON <br /> IYORINGIREMOYAL) 1:3 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> $l HAZARDOUS WASTE GENERATOR E3MOTELMOTEL ❑ PUMPER TRUCKIYARDlCHEM TOILETS <br /> SI TIERED PERMITTED FACILITY .. ❑ POOLISPA LAND USE APPLICATION SITES <br /> d TATTOOIBODY PIERCING b OTHER(PLEASE SPECIM <br /> ❑ MEDICAL WASTE FACILITY <br /> q. List up to telies <br /> n addresses in the space above. MUST be sth elected f Fax to(209)Trom 4 files from the(64-0138ist vorbma to they <br /> the appropriate box(es). At least one Tile typ <br /> address indi ted alpP e. y ointment for review will be eonfirrned <br /> 2, EHD will noti thea licant if an EHD files exist An apPa on. The of a <br /> approximately five business days but no later than ten(10i days afterr101eieptshou dpbe schedu edfiles <br /> will be held for a maximum of five business days for review. Appo <br /> accordingly. y EHD staff may nat be Immediately available for review- Ane' <br /> 3, A file that is active) being worked on by EHD staff at the expens <br /> application may be submitted when the file is available. anized by <br /> 4. Any file not returned in the same condition as released will be reor ulre a 93.00 deposit prior to revie <br /> of the applicant Future file reviews by the same applicant may req S <br /> 6. -TENTATIVE <br /> receivedafter 3:00 pm wiates must ll be processed e confirmed lthe neat th EHD bu business day. <br /> 6. Applications <br /> TIME <br /> CONFIRMED APPOINTMENT DATE INfT1AL5 ' i <br /> DATE CONFIRMED "PHONE FAX' <br /> REVIEWED % <br /> YES No REVIEW DATE <br /> • enp uaz-0ve <br />