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06/27/2005 11:35 FAX 209 9480621 f�002/002 <br />1DATERECENED ( SAN JOAQUIN COUNTY <br />�(�cJJ���I � ENVMO NNIENTALHEALTHDEPARTMENT <br />(% t� 304 E We6er'Ave 311 Floor Stockton, CA 95205 <br />1,;i4 2 1(709468-3420 Fax: (209) 464-0138 Web: www.cc.sm-Paquin-mus/chd 72, <br />EtiViRON P4? } EW6 PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />} <br />—r <br />TENTATIVE' APPOINtMENT DATE: V� Time= <br />(Please aliaw 10 business days from date Of aPPliattion submMal) <br />0 CHECK BOX To EXPEDITE REQUEST - $93.00 FEE- REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT4:�Z&M 7�wk DATE <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNIT <br />Unit 1 <br />nit 2 <br />///yf Unit 3 <br />Val <br />Yunit <br />4 <br />ynit s <br />L)"A �9 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) a HOUSING ABATEMENT RL SCUD WASTE FACItJTy <br />OSTLER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY r3souo WASTE VEHICLE <br />� UNDERGROUND TANK (MON(TORINGIREMOVAL) U. DOG KENNEL t9- DAIRY <br />AS KAZARDOUs WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br />a MOTEIJHOTEL ❑ LAN USE AUCK/YARO(CHEM TOILETS <br />❑ TIERED PERMhTED FACILITY ❑ Ppp�PA ®, LAND USE APPUCAT70N SffES <br />❑ TXTTOOIRODY mroIcALWAST F PIERCING I FRSE SPCCI <br />❑ MEDICAL WASTE FACILfTY ❑ OTHER (P_ <br />List up to ten addresses. in the space above. Select the types) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (2091 464-0138 or mail to the <br />addressindicated above. <br />z, EHD will notify the applicant if any EHD files exist An appointment for review will he confirmed <br />appr6ximately rive business days but no later than ten (10) days after receipt of application. The files <br />will be held for a maximum of rive business days for review. Appointments should he scheduled <br />accordingly. <br />3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A -Se' <br />application may be submitted when the file Is available. <br />C Any file not returned in the same Condition as released will be reorganized by EHD staff at the expens <br />of th'e applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to revie <br />5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />g• Applications received after 3:00 pm wilt be processed the next business day. <br />:CONE RMS :i rt:' � ' TIME ^"r w - ::J_:, T <br />( APPOINTMENT PATE <br />'AATE.Cti. FIRMED <br />..PHONE FAX <br />REVIEWED YES NO PEVIEW DATE - <br />