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03/18/2005 11:59 FA% 209 94801 1x002 <br /> s _ <br /> - ATE RECEIVED <br /> SAN JOAQUIN COUNTY <br /> pJ[EMEDENvIRONN1EfAL EALTHDEPARTMENT <br /> C <br /> 304 E Weber Ave 3`a Floor Stockton;CA 95205 <br /> VAR 1(�ft(j§$-3420 Fax: (209) 464-0138 Web: www.co.san joaquiaca.u5/ehd <br /> ENVERONN'ENT REALUBLIC RECORDS RELEASELATPLICATION <br /> , 1 <br /> APPLICANT_ � -N-L) +�6� BUSINESSIAGENCY: <br /> ADDRESS:., z \_ 1 l si- q—r r( err P,r Ch- vn. <br /> PHONE: i7d�� -FACSIMILE; <br /> TENTATIVE'APPOINTMENT DATE nme: <br /> (Please allow 10 buslnrss days from data of application submittal) 17FILEWR <br /> CHECK BOX TO EXPEDITE REQUEST•391.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT -) DATE _.75WUSr <br /> Oeo,artmem Use Only <br /> UNIT <br /> st <br /> 0042a- 9-070-$ ILE ADDRESS <br /> c ! ❑ Unit 1 <br /> z. src� a <br /> a. seen( O - f , a r '"Jar UfLt 2 - \/✓1- <br /> 4. <br /> 40�u nit 3?ool //✓) <br /> b <br /> 6, SMCCI <br /> T sweet cNnl4 <br /> ❑ Unit 5 <br /> 9. So-M <br /> 1a. Sea, G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ' \VV <br /> UNOERGROUND TANK(UST)CLEANUP SITE(LOP) a HOUSING ABATEMENT Q SOLID WASTE VEHICLE J <br /> OTHER CLEANUP SrrE INON�OP) ❑ FOOD FACILITY <br /> a UNOERCaROUND TANK(MONITOR1NGIREMOVAL) 0 COG KENNEL E.DAIRY <br /> ffi HAZARODUS WASTE GENERATOR ❑ CHICKEN RANCH 03-PKG TREATM ENY PLANT <br /> ❑ TIERED PERMn TED FACIIXTY ❑ MOTELtHOTEL ❑ PUMPERYRUCKrlARo,CHEM TOILETS <br /> ❑ TATTOO/BOOY PIERCING Q POOLISPA 5L LAND USE APPLICATIONSITE <br /> ❑ MEDICAL WASTE FA.CIL" ❑ OTHER(PLEASE <br /> 1. List up to ten addresses in the space above. Select the type(s) of Tiles from the list above by checkinc <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 454.0138 or mail to the <br /> address-indicated above. <br /> 2. EHD will notify the applicant if any EMD Files exist- An appointment for review will be confirmed <br /> apprnximately 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. ne <br /> application may be submitted when the file is available. <br /> will be reorganized by EHD staff at the expen <br /> 4. Any file not returned in the same condition as released <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to revic <br /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> s, Applications received after 3:00 pm will be processed the next business day. <br /> ,.cel E r'*k`?r� ny:;, . �:.}:r'�'•0:�- <br /> APPOINTMENTp 47E ' -,ae, r.•. : - - <br /> -'?`i' q'PHONE•'. FAX':i:;'.+�•'..+: «"INlT.1ALs ;�2Y:'...1.. <br /> ,)ATE-i .QNEIRMED ~ �..,: .. <br /> REVIEWED YES 1,10REVIEW DATE' " <br />