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9/02/2004 12:09 FAX 209 9480021 0 002/002 <br /> V DATE RECEIVED , cnv w., <br /> IDI� - E� Il,`1//E SAN Jo�Quul CoYmTTx <br /> lnl ll v EwmonmN�I'AL HEALTa DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> MAR 0 2 2004(209) 468-3420 Fax: (209) 464-0138 Web:www.co.san joaq=' .ca.us/ehd <br /> ENVIRUNMENT HEA '[H PUBLIC RECORDS RELEASE APPLICATION <br /> P F <br /> ��K-ANr _ 1► SiA?-LI& S,__.BUSINESSIAGENCY:- <br /> ADDRESS: M <br /> _ ,`�DZS r <br /> PHONE: p1�t`�--i'��.1� FACSIMILE: "I qto b b'0 <br /> TENTATIVE*APPOINTMENT DATE: 0 L( Time: 1200 <br /> r <br /> I (Please allow 10 business days from date of applic4on subrnhi4 <br /> ripQ CHECK BOX TO t;,Wt;ul it REQUEST-$93.00 FEE—MQUESTPR09WED IN 3 BUSINESS DAYS � <br /> SIGNATURE OF APPUCANf DATE 3 DLI <br /> Deoarhneerd Use Only <br /> FILE ADDRESS UNIT <br /> • ,, S R-D 3-1. LZ 0) <br /> • Svee, v e�V ❑ Unit 1 <br /> 2. <br /> . Unit 2 <br /> 4. SReR 2 • t_0 �7 <br /> s. Sheet S 1 �.�. Unit <br /> G. surd 4a W <br /> • 7. su� ` <br /> Unit 4 <br /> e. Secy t' I _ <br /> S.."` MAP 2004 ❑ Units <br /> Ply <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> AK UNDERGROUND TANK(UST)CLEANUP SFTE(LOP) a HOUSING ABATEMENT AM SOLID WASTE FACILITY <br /> P:OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACZM ❑ SOLID WASTE VEHICLE <br /> $UNDERGROUIJ D TANK(MONMORINW/ EM OVAL) ❑ DOG KENNEL 49: DAIRY <br /> Er HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH a PKG TREATMENT PLANT <br /> ❑ TIERED PERM'TFED FACILITY ❑ moTELMOTEL ❑ PUMPER TRUCK/YARD0CHEM TOILETS <br /> ❑ TATTOOIRODji N A <br /> PIERCING I] POOUSPA 19 LAND USE APPLICATION SITES <br /> C3 MEDICAL WA'f' E FACILITY ❑ OTHER(PLSE SPECIFY) 0 <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. EHDI•will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> appSoxlmately 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 /> accv�dingly. . <br /> 3. A file 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. An file not returned In the same condition as released will be reorganized by EHD staff at the expense <br /> of thie applicant. Future file reviews by the same applicant may require a$93,00 deposit prior to review <br /> S. 'TENTATNE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> lrra . , 'TIME <br /> NEI,�MrTDO <br /> �DA7E-GONI+IRMED 'r v <br /> �I .PHONE FAX , •.�'dN)TIALS <br /> RMEW.ED i YES NO REVIEW DATE. <br /> ENO�a-0z-0o6 <br /> arerzoo� I� ' <br />