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11/02/2004 10:04 9168610$30 SECOR PAGE 02/0 <br /> �s �� 07/2004 15:10 464p ENVIRONMafTAl- LTH PAGE 01 <br /> f- DATE RECEIVED - WiD LOG NUMBER <br /> ;At JOA- QUIN COUNTY <br /> LL; NTTIRONMENTA L HEALTH DEPARTMTNT <br /> 304 B Weber Ave 3`1 Floor Stockton,CA 95205 <br /> NOV 0 2 M409)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.caus(ehd 1 <br /> 6 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> Zoe <br /> 7ADnRIE:$$- <br /> )q <br /> r: h nuSINESStACRNCY: tCTI' 7h4�L✓Y1Gt07cYQ <br /> /p�PHONE: ( lI LD g(01- �U FACSIMILE:..(C)/(d) so/-04,30 - <br /> TENTATIVE"APPO(NTMENTDATE:_ 11-5-- Oy Q UDCIw. � F�-r <br /> (PIQA9a altow10btWnessdays fromdate ofappikationsOmittoq f� <br /> r�' w :'; <br /> CHECK BOX TO EXPEME REQUI53T-S93.a0 FEE—�REQ.UE^ST PROCESSED W 3 HUSME55 DAYS - <br /> SIGNATURE OF APPLICANT _ DATE 1/-I-OSI <br /> I <br /> Dwm m N Use Ody . <br /> FFU ADDRESS UNIT <br /> z YaC C bV r A a� 5 <br /> i seen 2 P � Avg, Shu eg � d 1 <br /> a, s <br /> n In/ � <br /> ai ` / �� ` /" Unit 3 <br /> <:: P fz CA 12 <br /> Unit4 <br /> S� ?/ ctr <br /> 10. q0 <br /> Lipicyelo Zvoa S <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �{+ <br /> ,A(UNDERGROUND TANK(UST)CLP.ANUP SITE(LOP) O HOUSING ASATMMCNT b SOLID WASTE FACILITY r . <br /> O OTHER CLEANUP SITE(NON{OP) 0 FOOD FACILITY O SOLID WASTE VEHICLE <br /> T;UNDERGROUND TANK(MO"rI`O e'WRpMOVA1} D BOG KENNEL O DAMT ' <br /> WHAZARDOUS WASTE GENERATOR O CHICKENRANCH , 13 PKG TREATMENT PLANT <br /> d TIERED PERMnTED FAGa,ITY 0 MoTEUHOT£L G PUMPER TRUCWAROICHEM TM TS <br /> ❑ TATTOOBODY PIERCING - 0 POOUSPA krtAND USE APPLICATION SRES <br /> O MEDICAL WASTE FACILITY O OTHER(PLME SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the.type(s)of files from the list above W checking <br /> the appropriate box(es). At least one file type MUST be selected Faxo. tt 2091-464 0138 or m$11 to3ae <br /> address Indicate above <br /> 2. EHD will notify the applicant if any EHD 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 fifes <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 aetiveiy being worked on by EHD staff may not be immediately available for review, A new <br /> Application may be submitted when the rile 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 /> 3. 'TENTATIVE appointment dates must be confirmed with EHP staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> -0Cy'.NFIkMED APP6INtMENT,DATE _ TIME <br /> D4YECON1iZNIEiS 'P.HONE FAX INITYJLS i <br /> \ f2EVllE1NED YES NO REVIEW DATE <br /> EIN�Ba3ovR <br /> � • nrw, <br />