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10/14/2004 17:20 209467141 AGE STOCKTON PAGE 01/0 <br /> f <br /> \/ EHD LOG NUMBER <br /> DATE RECEIVED . ) i'; SAN JOAQUIN COUNTY, <br /> ENVIRONWNTAL REALTH DEPAI2 ENT Z,07 n 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> 468-3420 Fax: (209)464-0138 Web: www-co.san-joaquin.ca.us/ehd <br /> ;I,I;U,`; di fdT k,LpJo <br /> n, �,�• if;FS PUBLIC RECORDS RELEASE APPLICATION <br /> Qd�an[�� �t,o,��tiy�rnn <br /> pppLICANT: azQ BUSINESS/AGENCY� ��-- <br /> S cv S a� <br /> ADDRESS: I `/- 0ry 1. !_ *7 - dl (� <br /> PHONE: 7 (9 ! ��QQ� FACSIMILE: S�J//(O D / <br /> Cl?/ D qday Time: <br /> TENTATIVE*APPOINTIteENT DATE: <br /> �1 (Pkase allow to business days from data of application submittal) <br /> fy{b CHECK BOX TO EXPEDITE REOU - 1.00 FEE-RE4UE T P OCESSED IN 3 BUSINESS DAYS /O l <br /> DATE <br /> SIGNATURE OF APPLICANT Depamnant use OnlY <br /> i <br /> FILE ADDRESS •,� <br /> a N <br /> 2. Sat I t M <br /> r� <br /> cite <br /> Btteel A �� :a <br /> 3 at ma G ,� ayecly <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ SOLID WASTE UNDERGROUND SANK(UST)CLEANUP SITE(LOP) O HOODING ABATEMENT CI SOLID WASTE <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY <br /> UNDERGROUND TANK(MONITORLNGrREMOVAL) O DOG KENNEL DAIRY <br /> O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR M MOTELIHOTEL ❑ PUMPER TRUCK/YAROICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY d POOL/SPA 0 LAND USE APPLICATION SITES <br /> d TATTOOIBODY PIERCING ❑ OTHER(PLEASE SPECIFY) <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 least 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 flies exist. An appointment for review will be confirmed <br /> approximately <br /> P be held for ave business days but no later than e <br /> maximum of five business days forreviewapplication.110)days after receipt of <br /> . Appointments should scheduledrles <br /> accordingly. <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 rile 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$93.00 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 /> IME .- <br /> CONFIRM: APPOINTMENT:DATT? <br /> DATE CONFIRMED _ - PHDNE FAX <br /> REVIEWED YES NO.. <br /> REVIEWDA E <br /> enP eea2465 <br /> uetmoe <br />