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12/01/03 MON 17:13 FAX 916 929 2742 EARTH TECH-SACRAMENTO Ro <br /> 12/111/2003 16:53 4640138 ENVIRONMENTAL <br /> _ <br /> rR <br /> ,i 1 PAGE 01 <br /> c ,I l ICHV�Vu IvvrvloC� SAN JOAQUIN COUNTY <br /> 2003 ENviRUNmFNTAL HEALTH DEPARTMENT <br /> DEC 304 E Weber Ave 3`d door Stockton, CA 95205 q5 <br /> .Igl'rt ',AHP 11ENT QMA68-3420 Fax: (209)464-0138 Web: www.co.san_joaquin.ca.ug/ehd <br /> p;-:'N,IT;SERVICES <br /> 1/` PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Loch, K,! SUSINESS/AGENCY: Ea-� TeC'-LN <br /> ADDRESS: (Dr-5//5 <br /> 1 � i�L tM-2 KA C � ' q S <br /> HONE: �1�' 12 I' 41y3 X tea- FACSIMILE: q I (-o `q29- 9-� <br /> fi cry u1 e Q-k <br /> TENTATIVE C�APPOINTMENT DATE: &6 12A 8Time: <br /> (Please allow 10 business days from data of application submittal) <br /> r: f! <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> .*SIGNATURE OF APPLICANTA�2DATE I I I I U 3 <br /> Department Use Only <br /> FILE ADDRESS UNIT _ <br /> t, sr<ea, 3 S (Uav 1�('tve c, ❑ Unit t <br /> 2. Skeet /` I <br /> City <br /> ]. 3lreel <br /> city <br /> CI `�[ Y <br /> Unit 3 <br /> 6, Street <br /> 7. stleel 16 nit 4 <br /> e. Flr�cl <br /> 4. sr•a <br /> CRY Unit 5 <br /> to. 9vaee G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> dUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ 90UD WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) D FOQD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MON ITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH D PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEL1HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILET <br /> 13Of <br /> TATTOBODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> D 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 ne <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 ekpen! <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to revie <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 /> -- i —i <br /> CONFIRMED APPOINTMENT DATE TIME To <br /> Go./Dept <br /> DATE CONFIRMED PHONE FAX Phono 0 <br /> RF,VIEWED YES NO REVIEW DATE Fax K 9- z J <br /> GH13 4E 0 <br /> W 2/200] <br />