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06/18/2005 15:39 FAX 209 94808 10002/0.0,1 <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENYMONMFNTAL HEALTE DEPAItDUNT <br /> 304 E Weber-Ave 3"` Floor Stockton, CA 95205 I qAjZ <br /> r' � �8=3420 Fax: (209) 464-0138 Web:ww <br /> IR <br /> w .co.saI1joaquin.caus/ehd o <br /> jUN 0i ?00`- UBLIC RECORDS RELEASE APPLICATION <br /> APPU V� p` BUSINESSIAGENCY: <br /> ADDRESS! t f � p ' <br /> PHONE: FACSIMILE: <br /> TENTATIVE APPOINTMENT DATE:y Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX YO EXPEDITE REQUEST-$9100 FEE—REQUEST PROCESSED IN 7 BUSINESS DAYS <br /> DATE ,N6 I6045 <br /> SIGNATURE OF APPLICANT oepartrnent lFse y <br /> UNIT <br /> FILE ADDRESS <br /> G 0 Unit 1 <br /> I, sued 1 <br /> XOT <br /> ' G <br /> z sa a is w Unit 2 1\� <br /> Unit 3 <br /> 6. sued <br /> G <br /> 1, soca <br /> G <br /> su.d ] Unit 5' <br /> G <br /> 9. SYE64 <br /> G <br /> io• slr�a Vnit(p <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> OI.SOLID WASTE FACILITY <br /> UNDERGROUND TANK,(UST)CLEANUP SITE(LOP) G HOUSF0430ING <br /> AB <br /> T MENT a SOUR WASTE VEHICLE <br /> OTHER CLEANUP SITE <br /> EN -.OP) ❑ DOG KENNEL i�DAIRY <br /> a UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN REL �PKG TREATMENT PLANT <br /> ,� I{gZAItDOl15 WASTE GENERATOR ClMoTELJHDTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FAC11-nY ❑ Pgp❑5PA M LAND USE APPLICATION SITES <br /> Q TATT00/121013Y PIERCING ❑ OTHER(PLrASE SPECIFY) <br /> U MEDICAL WASTE FACILITY <br /> t, List up to ten addresses in the space above. Select the type(s) of files from the list above by checkinc <br /> - the appropriate box(es). At least one Fite type MUST be selected. Fax to209 464-0138 or mail to the <br /> address.indimited above- <br /> 2, EHD will notify the applicant if any s but Dfiles exist.ao later than t n (10) days akeent �rece"pt of applicaConr review Will be �The files <br /> approximately five business day <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, A ne <br /> application may be submitted when the file is available. <br /> q. Any File ne;IcariL Future file reviews by the same applicant returned in the Same condition as lmay require a $93.l be reorganized by 0 deposit prior to ren, <br /> of th'e app e <br /> 5, . 'TENTATIVE appointment dates must he confirmed with EHD staff. <br /> G. App0cWicris received after 3:00 pm Will be processed the nextbusiness day. <br /> ' i�' l i+ '• ». .vlL'YX[ .iYFY.h.Y. <br /> NF1,RME 'TIME <br /> D, APFOINTMNT1)A7.E: v: <br /> ' • ...: ;�.' FAX <br /> PHONE <br /> CaQNFL. MED 1.. ,;•' ,.: <br /> rRVIEW <br /> ED DYES <br /> NO' REVIE4V DATE <br />