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11.21 ACS STUCKTON PAGE 01/F. <br /> D11 _rte Mfr_ <br /> DAT£RECIVE<7 WV EHO LOG NUMBER <br /> SAN JOA.QUIN COUNTY <br /> APR L 5 2004 ENVIRONMENTAL HEALTH DEPARTMENT � <br /> 04 E WeAve <br /> 3 Weber Av 'P Floor Stockton,CA 95205 <br /> 7 <br /> . <br /> 1CS468-•3420 Fgx: 209 464-0138 Web:www.co.san-joaquin.ca.us/ehd a3 ! <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> -APPLICANT: 6lISINESSfAGENCY: <br /> '` tupm �^ <br /> ADDRESS:+]'R3,7 qA W (I OA J <br /> PHONE:_d_Q�. Y� MO&� FACSIMILE: <br /> ar e�r�lre�^ <br /> '.TENTATIVE"APPOINTMENT DATE: imo. .� <br /> (Please allow 10 buaanoss days from date of application submtUall F C <br /> CHECK BOX TO EXPEDITE REQ ST-$93.00 FEE-REQUE OCE SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICA DATE ! O <br />€ Department Use Only <br /> E f <br /> FILE ADDRESS UNIT <br /> �o n o c <br /> f °°d � Unit 1 <br /> 2. S o h lirUML. <br /> a <br /> M "11:2 <br /> 4. s +�an <br /> s. s Unit 3 d <br /> JrA <br /> Unit 4 � <br /> a. 5 <br /> B. 5&6ei c Unit 5 <br /> s0, Samr c <br /> E ' <br /> NVIRONMENTAL HEALTH DEPARTMENT FILES <br /> � I <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING AIIATEAIENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) G FOOD FACILITY ra SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 13 DAIRY <br /> HA74RbOVS WASTE GENERATOR Cl CtfiCKEN RANCH ❑ PK(i TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELlHOTEL O PUMPER TRUCKIYARD A <br /> ❑ TATTOOBODY,PIERCING 0 POOLISPA O 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 Ilst above by Checking <br /> the appropriate box(es). At Idast 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)clays 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 fle'l: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 END 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 /> 6. "`TENTATIVE appointment dates must be confirmed with EHD staff. 4 <br /> 6. Applications received after 3:00 pm will be processed the next business day. RUSH <br /> i <br /> CONFIRMS0 APPOINTMENT bAtt., TIME: <br /> DATE CONFIRMED PHONE.; : FAX . INITIALS <br /> RE.VIPVMD . YES NO REI/IEVU DATE <br /> EMD�8-G2-006 - <br /> IM2000 <br /> i <br /> I <br />