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9/02/2004 12:09 FAX 209 9480091 Z 002/002 V DATE RECEIVED I cnv w., IDI �- E� Il,`1//E SAN Jo�Quul CoYmTTx lnl ll v EwmoN mNTAL HEALTa DEPARTMENT 304 E Weber Ave 3`d Floor Stockton, CA 95205 MAR 0 2 2004(209) 468-3420 Fax: (209) 464-0138 Web: www.co.san joaq=' .ca.us/ehd ENVIRUNMENT HEA'[H PUBLIC RECORDS RELEASE APPLICATION P F ��K-ANr _ 1► SiA?-LI& S, __.BUSINESSIAGENCY:- ADDRESS:M _ , `�DZS r PHONE: p1�t`�--i'��.1� FACSIMILE: "I qto b b'0 TENTATIVE* APPOINTMENT DATE: 0 L( Time: 1200 r I (Please allow 10 business days from date of applic4on sutxnhi4 Q CHECK BOX TO E,WtEul it REQUEST - $93.00 FEE— MQUESTPR09WED IN 3 BUSINESS DAYS - � (� r SIGNATURE OF APPUCANf DATE 3 DLI f Deoar wxlt Use Only ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK (UST) CLEANUP SFTE (LOP) a HOUSING ABATEMENT AM SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOUD WASTE VEHICLE $ UNDERGROUIJ D TANK (MONMORINW/ EM OVAL) ❑ DOG KENNEL 49: DAIRY Er HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH a PKG TREATMENT PLANT ❑ TIERED PERM' TFED FACII_17Y ❑ MOTELMOTEL ❑ PUMPER TRUCK/YARD0CHEM TOILETS ❑ TATTOOIEIODii PIERCING O POOUSPA iia' LAND USE APPLICATION SITES 17 MEDICAL WA'f ' E FACILrrY ❑ OTHER (PLEASE SPECIFY) 0 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2. EHDl,will notify the applicant if any EHD files exist. An appointment for review will be confirmed appSoximately five business days but no later than ten (10) days after receipt of application. The Files will be held for a maximum of five business days for review. Appointments should be scheduled accv�dingly. . 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. An file not returned In the same condition as released will be reorganized by EHD staff at the expense of tFie applicant. Future file reviews by the same applicant may require a $93,00 deposit prior to review S. 'TENTATNE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. APPOINTIMEDATE < r ` >_ :TIME j 1 -DATE-CONI+IRMED 'r v �I PHONE FAX• "' -.-111,4 IAL -S REVIEVV.ED i YES NO REVIEW DATE. Ana093 UNI' D Unit 1 oe Unit 2 Unit + -T " A w w w Unit 4 004 ❑ Unit s ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK (UST) CLEANUP SFTE (LOP) a HOUSING ABATEMENT AM SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOUD WASTE VEHICLE $ UNDERGROUIJ D TANK (MONMORINW/ EM OVAL) ❑ DOG KENNEL 49: DAIRY Er HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH a PKG TREATMENT PLANT ❑ TIERED PERM' TFED FACII_17Y ❑ MOTELMOTEL ❑ PUMPER TRUCK/YARD0CHEM TOILETS ❑ TATTOOIEIODii PIERCING O POOUSPA iia' LAND USE APPLICATION SITES 17 MEDICAL WA'f ' E FACILrrY ❑ OTHER (PLEASE SPECIFY) 0 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2. EHDl,will notify the applicant if any EHD files exist. An appointment for review will be confirmed appSoximately five business days but no later than ten (10) days after receipt of application. The Files will be held for a maximum of five business days for review. Appointments should be scheduled accv�dingly. . 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. An file not returned In the same condition as released will be reorganized by EHD staff at the expense of tFie applicant. Future file reviews by the same applicant may require a $93,00 deposit prior to review S. 'TENTATNE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. APPOINTIMEDATE < r ` >_ :TIME j 1 -DATE-CONI+IRMED 'r v �I PHONE FAX• "' -.-111,4 IAL -S REVIEVV.ED i YES NO REVIEW DATE. Ana093 UNI' D Unit 1 oe Unit 2 Unit Unit 4 004 ❑ Unit s ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK (UST) CLEANUP SFTE (LOP) a HOUSING ABATEMENT AM SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOUD WASTE VEHICLE $ UNDERGROUIJ D TANK (MONMORINW/ EM OVAL) ❑ DOG KENNEL 49: DAIRY Er HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH a PKG TREATMENT PLANT ❑ TIERED PERM' TFED FACII_17Y ❑ MOTELMOTEL ❑ PUMPER TRUCK/YARD0CHEM TOILETS ❑ TATTOOIEIODii PIERCING O POOUSPA iia' LAND USE APPLICATION SITES 17 MEDICAL WA'f ' E FACILrrY ❑ OTHER (PLEASE SPECIFY) 0 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2. EHDl,will notify the applicant if any EHD files exist. An appointment for review will be confirmed appSoximately five business days but no later than ten (10) days after receipt of application. The Files will be held for a maximum of five business days for review. Appointments should be scheduled accv�dingly. . 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. An file not returned In the same condition as released will be reorganized by EHD staff at the expense of tFie applicant. Future file reviews by the same applicant may require a $93,00 deposit prior to review S. 'TENTATNE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. APPOINTIMEDATE < r ` >_ :TIME j 1 -DATE-CONI+IRMED 'r v �I PHONE FAX• "' -.-111,4 IAL -S REVIEVV.ED i YES NO REVIEW DATE. Ana093