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- EHD LOG NUMBER <br /> DATE RECEIVED_ SAN JOAQTAN COUNTY ` ' <br /> s;l(?I� <br /> Fc E� I `� F�IU' ]ENVfRONMENTAL I�EALTH DEPARTMENT <br /> 304 E Weber Ave 3ra Floor Stockton, CA 95205 <br /> AUG 3 0 2004 (209) 468-3420 Fax: (209)464-0138 Web: www.co.sari-Joaquin.ca.uslehd <br /> EjNVIRUMAEN I iIELALT l <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> PF_Rj!j1kT SFRVICES <br /> r ! r //.1 u l N i <br /> APPLICANT: G S/`� BUSINESSIAGE=NCY: <br /> ADDRESS,__F_-_0 f3 e <br /> Q FACSIMILE: <br /> PHONE: r <br /> ' Time: <br /> TENTATIVE*APPOINTMENT DATE: a3 <br /> e allow <br /> 14 business days from date of application submittal) <br /> /�leas , <br /> y <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$9 FEE--R ST PROCESSED IN 3 BUSINESS DAYS <br /> DATE, <br /> -�o <br /> SIGNATURE OF APPLICANT Department Use Only <br /> UNIT <br /> FILE ADDRESS `"dar <br /> r�g� G sr�c w a L ❑ Unit 1 <br /> 49A9 �. <br /> n/E v G r o <br /> 2. street Unit 2 <br /> Ci <br /> 3. Street ' r <br /> 4. sheet ? g Unit 3 <br /> G I <br /> 6. street a <br /> Ci <br /> 7. street <br /> oty <br /> 8. Street U(7j(5 <br /> 9. Street <br /> .h <br /> ,0- Street <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> / ❑ HOU ABATEMENT a ❑ SOLID WASTE FACILrTY <br /> �f UNDERGROUND TANK(UST)CLEANUP SITE(LOP) `' ❑ SOLID WASTE'VEHICLE <br /> Er OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY C3 <br /> UNDERGROUND TANK(MONITORINGIREMOVAL} CHC3 DOG KENNEL <br /> 13❑ ICKEN RANCH ,I PKG TREATMENT PLANT <br /> ljy HAZARDOUS WASTE GENERATOR 1 ❑ MOIELIHOTEL ❑ 'PUMPER TRUCKIYARDICHEM TOILETS <br /> EITIERED PERMITTED FACILITY C3 POOLlSPA ;l V LAND USE APPLICATION SITES <br /> ❑ TATfOOIBODY PIERCING ;k <br /> OTHER(PLEASE SPECIFY) <br /> E3 <br /> ❑ MEDICAL WASTE FACILITY <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 feast one file type MUST be selected. Fax to 209 464-0138 or mail 121M <br /> F address indicated above. nfirmed <br /> . <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for review will be co <br /> approximately five business days but no later than ten(10)days after <br /> rer e receipt should be tion. The ledfiles <br /> will be held for a maximum of five business days for review. App . <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for.review. Anew <br /> application maybe 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$93.04,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 DAT <br /> E ,TIME <br /> GATE CON1RMEp w PHONE FAX :INITIALS <br /> REVIEWED YES NO REVIEW DATE. .. <br /> EHD 48412-006 ., - <br /> r. <br /> 878!2907 <br />