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DATE RECEIVED �� pnvLwt�vmo�n <br /> SAN JOAQUIN COUNTY <br /> EN�ONMENTAL HEALTH DEPARTII� SIT -bill <br /> 304 E Weber Ave 3'd Floor Stockton,CA 95205 <br /> (209) 468-3420 Fax: (209)464-0138 Web:www.co.san-joa'quin.ca.us/ehd, <br /> FEB 0 9 2004 <br /> ENVIRONMENT HEAi IH PUBLIC RECORDS RELEASE APPLICATION <br /> T/SE Ereu►c:� <br /> APPLICANT- 28 BUSINESSIAGENCY: i <br /> ADORs=ss: 1 I ,4 �i S 63 <br /> PHONE: S 3O ' rq4 Zg FACSIMILE: <br /> TENTATIVE*APPOINTMENT DA"Z"E: Time: <br /> (Please allow 10 bus! ss days from date of application submittal] <br /> �_ __.11 <br /> CHECK BOX TO EXPEDITE REQU T-593.00 FEE REE�ST PROCE ED 1 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT r <br /> _RE DATE <br /> Department Use Only <br /> UNIT <br /> FILE DRESS <br /> 1. sweet <br /> 3 �PL' 1 ,_ ,qc' 42 d Cl Unit 1 <br /> �-- <br /> 2. street 5 _�/ <br /> / [3 Unit 2 <br /> �. street _ - <br /> s. street Unit 3 <br /> r <br /> 6. StrcN <br /> 7. Street <br /> G Unit 4 <br /> S. Street <br /> G Unit 5 <br /> 8. Street <br /> 10. Strut <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> S(UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(HONE OP) ElFOOD FACiLrrY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑' DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY El MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TIERED ERMI TE FACICING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> 17 MEDICAL WASTE FACILITY ❑ OTHER(PLEASE 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 box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review wild be confirmed <br /> approximately 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. Afile that is actively being worked on by EHD staff may not be immediately 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'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 /> 5. *TENTATNE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business.day. <br /> CC�NFfRMED APPOINTMENTDATE TIME <br /> DATE CONFLRMED .. PNON1 FAX XN[T.fALS ` � <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48-02-006 - .. <br /> SM2G03 <br />