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08/19/2003 13:03 2094671118 AGE STOCKTON PAGEe 01/01 <br /> DATE RECEIVED,., tnu uw nurvtotr< <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL,HEALTH DEPARTMENT <br /> 1003 304 E Weber Ave 3'" Floor Stockton, CA 95205 <br /> 209468 3420 Fax: 209 4640138 Web: www.co.Fan-joaquin.ca_u5/� � <br /> E _ P LIC RECORDS RELEASE APPLICAUOr <br /> Lin I^ <br /> APPLICANT: RUSINESSIAGENCY: 'L��In1/ P �J (TP-O GIV��n"•"!• � <br /> j <br /> ADDRESS: $�JSp� /7 1_DQ tOCktO <br /> PHONE: otD /. /• �DD(p FACSIMILE:_ C?a a / 67, /8 1 <br /> nn it <br /> TENTATIVE`APPOINTMENT DATE: a- t./ 71me: ID ADD <br /> i <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REOU $93.00 FEE-REOU S PROCESSED IN 3 BUSINESS DAYS Q/ <br /> SIGNATURE OF APPLICANT DATE '� ` i p <br /> Depamnent Use Only <br /> FILE ADDRESS UNIT <br /> SbKr z 8Sd G601KI5 ci /l/ ❑ Unit 1 <br /> z. aneei 7 har 2r City tj <br /> a sr.r Ao 5 . CtUa U <br /> Y11'� ❑ nit 2 <br /> s. Sneer city <br /> swN a Unit 3 -I <br /> Unit 4 <br /> s. sircN G nit 5 I <br /> ,0. strut O <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY � <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT? <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS .i <br /> ❑ TATTOO180DY PIERCING . ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ 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 will 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. A file 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• 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day, <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIAL <br /> REVIEWED YES. NO REVIEW DATE <br /> er,ou za0c _ - <br />