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Oct 25 04 03: 49p P. 1 <br /> 10/25/2004 16:09 46401® ENVIR018.1•=NTAL HEAL PAGE 01 <br /> !'� EHD LOG NUMBER <br /> DATEPBCSMT <br /> SAN JOAQUIN COUNY <br /> 0 _1 2 5 2004 Fi rMRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave <br /> -01 3'�Floor Stockton,CA 9quin <br /> z0goPERP,I <br /> ENti'iF;U'•;fJfLivT HEAL 6!;;�^Est��ilrFc <br /> 468-3420 Fax: (209)464-0138 Web:www.co_san joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ��^le..l.l �i•�ol•�c..Q.P aINNEssrAGENCY• <br /> ADDRESs: Gf .5 b� �� l 9KYo <br /> PHONE: iOSV^+T�I' �' 7 FACSIMLLE; `�-�"�7i •� •O <br /> TiENNTATIMAPPowrMENTDATE: Mrd 1 2846r .: —+A <br /> P <br /> (PNos.snow 10 Emtsel.as days from dais d.ppKtialbn fV41mnXVAq <br /> 11 V1 - <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED N W <br /> $BUSESS DAYS <br /> SIGNATURE OF APPLICANT Ste` '�—"` DATE ( 0 �� J low <br /> . <br /> }jli stn rSb { a a rz �h ra Ft -PLS,+. 0"Mnenlus.ow <br /> FILE ADDRESS UNIT <br /> ✓P- qg_a Z «.� 500 ;A eft L' <br /> cy <br /> 6 <br /> 3 .. r..oI <br /> = <br /> 3 <br /> a. a \1 <br /> ,A, 7. 0� Mgt 2M <br /> Unit lRsIM <br /> 1D <br /> E3AN5 <br /> ry Un <br /> /1 <br /> v = <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROVIKI TANK NST)CLEANUP STYE(LO% O FOOD FA FACILITY <br /> RENT �SOUO WASTE VACUITY <br /> TMER CLEANUP SIZE(NONIDP) O FOOD KENNEL <br /> lv O DAIRY WASTE VEIIXCX-fi <br /> �DERGROVND TANK pAOHf10RINGIRfMO'FN-1 O DOG KENNEL DAIRY <br /> O CHICKRANCH �'PK GTREATMENT PLANT <br /> MOTE I <br /> �REDIPERMfITm FACLL.RY� ❑ MOTELMOTEL � ❑ PVNPER IRVCKNARDlCHEM TOQIL�ETa <br /> ❑ TATTOO/BODY PIERCNG E POOUSPA '/If LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY O OTHER(PLEASE SPECW%l <br /> 1. List up to ten addresses In the space above. Select the type($)of(lies from the list aboye by-hacking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 12091464.01i or mail to the V <br /> address Indicated above. <br /> 2. EHD will notify the applicant If any EHD flies exitt- An appo7ntmeM forrevi0w wHl be confirmed <br /> approximately Five business days but no later than ten(10)days after receiptnts tO�lpdpbe tion' Thee files <br /> will be held for a maximum of five business days for review. Appointor <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be Immediately available for review. new <br /> application may be submitted when the file is available. b EHD stall at the expanse <br /> 4- Any file not returned in the Same Condition as released wilt be reorganized Y <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> m5 "TIENTATIVE appointment dates must be Confirmed with EHD stall. <br /> B- Applications received after 3:00 pm will be processed the next business day. <br /> 7 . ' <br /> fO�ONF.fRMED'. POINtMENT DATE TIME <br /> OATECONMRMIb PHONE . FAX '• � : <br /> .MEWED YES - NO REVIEW DATE <br /> waaaw <br />