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RUG. -17 09 (TUE) 19:08 VERSAR, INC. TE1,:9169622618 E. 001 <br /> �! } J PATEtEC# 6HD LOG NUME3ER <br /> �- 4='!f SAN JOAQUIN COUNW <br /> AU 1 '� 2004 EWMONMENTAL HEALTH DEPARTMENT <br /> __. 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> H�A�j�09)468-3430 Fax: {209)464-0138 Web: "vw•ca,san;juEtquin.ca.us/ehd <br /> bD <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:yln- l& cmnnygy guSINESSIAGENCY: <br /> AppRE5S <br /> PHONE: 5 FACSIMILE: <br /> TENTATIVE*APPOINTME=NT DATE: Tyne: _ l n(14n <br /> (Please allow In business twe from data of applcation submImi) <br /> eCHECK BOX TO EXPEMTE REOUEST•493,00 FEE-REQUEST PROCESSED INS BUSINESS DAYS <br /> SIGNATURE OF APPLICANT I LPZ DATE O <br /> f <br /> D903 t ad Use Only <br /> LE ADDRESS UNIT <br /> rAA U6 A) Unit 9 <br /> fl2 <br /> . s99nueeeelt o Gi <br /> u r yrs <br /> :TICCAr__ 4015 <br /> Alt& Q Unit 2 <br /> 4. 4- n <br /> s c Unit 3 <br /> 7 I � <br /> g6ft <br /> Uni <br /> 64ee1 <br /> cpy <br /> a s01, C3 Unit 5 <br /> �' 91nat G <br /> Y1+ ENVIRONMENTAL HEALTH G115-PARTMENT FILES - <br /> U DERE OUND TANK[USTI CLEANUP SITE(LOP) ❑ HOUSING ARTF-MFNT M SGL113 W I <br /> V OTHER CLEANUP SITE(NOWLOPI 4 FOOD FACILITY .0 SOLID WASTE VEHICLE <br /> WUNKRGROUND TANK(MONITORINCIniEMOVAL) CI DOCS KENNEL C3 DAIRY <br /> Ili HAZARDOUS WASTE GENERATOR M CHICKEN RANCH n PKG TREATMENT PLANT <br /> O TIERED PE=RMITTED FACILITY n ImOTEUHOTEL lD PUMPER TRUCKIYARDICHEN TOILETS <br /> * TATTOOISOPY PIERCING 13 POOVSPA CI I-AND USE APPLICATION 8ITE9 <br /> A MEDICAL WASTE:FAC=ILITY M OTHER(PI.FASR sPECIfY) <br /> 1. List up to ten addresses In Me 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.12[I91464-0139 or malt to the <br /> pffless IndIcatod ahove. <br /> 2. EHP will notify the applicant If any Ek 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 flies <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 SKID staff may not be Immedlately 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 raorgarnlzed by EHD staff at the expanse <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 allg <br /> 3 <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIMED YES NO REVIEW DATE <br /> uinoaia:tea7AI��t.,�'; f'r �-- I� (.Lr1[ � �Gf%i!? . <br />