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08/09/2004 12:13 ATC F,-,.jCIATES 4 12094648138 N0.936 D4J <br /> DAT�:RE_ ��' E)iD LOG NUMBER <br /> �� S LN J0AQU1N COUNTY <br /> - <br /> ENVIRONMENTAL HEALTH DEPARTNma <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> p�G (209)468-3420 Fax: (209) 464-0138 Web:wvw.co.san-joaquin.ca.ul./ehd <br /> �>V�ltn � �1GES 1P <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> P � <br /> APPLICANT:- 'I F BUSINES$1AGENCY. i C s 1-° <br /> ADCRESS: L is O Z U-.W—r ao �} <br /> PHONE:_9 2 1 FACSIMILE: <32 S 3 <br /> TENTATIVE"APPOINTMENT DATE:�� � TIM: <br /> (Plea&&allow 10 business days from date of application aubmfttal) <br /> CHECK BOX TO EXPEDITE REQULST-i FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPi3CANT DATE <br /> 9A— <br /> DepErtmnt Usa Only <br /> FIL DORESS UK7 <br /> w a G lJn{[1 <br /> i <br /> suet '� (e Qz7 a rJ m t/-4w <br /> tc 11:; <br /> U <br /> r. smut city �llnit 4 <br /> i stmet ety <br /> 9. Sores <br /> ❑ Unit 5 a <br /> to $too cl <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILESvt <br /> I <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) n HOUSING ABATEMENT SOUR WASTE FACILITY <br /> OTHER CLEANUP SITE(NON4.01P) ❑ FOOD FACILITY SOLID WASTE VEHICLE LL l <br /> 10 LINOERGROUNO TANK(IAONITORINGMENOVAL) M DOG KENNEL DAIRY Irl <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH PKG TREATMENT PLANT I <br /> TIERED PERUTTED FACILITY n MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS 1 <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑ OTHER IPLEA3f 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 boxes?. At least one 1110 type MUST be selected. Fax to(209)454-0136 or mall to the <br /> address!AdIC21ted above. <br /> 2. END wilt notify the applicant If any EHD files exist. An appointment for review will be conf nned <br /> approximately five business days but no later than ten(14)days after receipt of application. The tiles � <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 FHD staff may not be Immedlatefy 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 EMD staff at the expense <br /> of theapplicant Future file ravleWS by the same applicant n►ay mqulre a$93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHO sta#f. <br /> 6. App(lcatlons received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME . <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EMO 4W1-0o� <br /> weraoa� <br />