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Jun . 17 . 2004 4.40PM Vt'—�NVIRO 209369 .4228 i r No •5514-`{'`P • 2`""' <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> � 1 <br /> ; , ENVIRONMENTAL HEALTH DEP�AgTMENT <br /> 304 E Weber Ave 3 Floor Stockton, CA 45205 <br /> 2�� p9) 468.3420 Fax: (209) 464-0138 Web: www.co-san-iaaquin.ca.uslehd <br /> 963 <br /> ,SUN 1 7 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> -t iN <br /> BUSINESSIAGENCY: +"(2,( �' � 5-,n u� <br /> Ap <br /> IC T: <br /> ADDRESS: V ZZ <br /> FACSIMILE: <br /> PHONE: <br /> TENTATIVE*APPOINTMENT DATE: 2—6z, + <br /> (Please allow 10 business days from date of application submittal) <br /> 1 <br /> � ❑ CHECK BOX TO F-xP><D1TE REQUEST-$93.40 FEE-�R ST PROCESSED IN 3 BUSINESS DAY <br /> �j DATE <br /> I SIGNATURE OF APPLICANT Department use Only <br /> UNl <br /> FILE ADDRESS <br /> e rAc- � 9 nit 1 <br /> 36a r, (rr � <br /> At G r-� �� 3 a� fl nit 2 a ) <br /> sleet ! 116 <br /> 4. Street I i� Unit 3 <br /> 5. Slreel <br />� - CL <br /> 6. StreetCil �3} Unit <br /> 7. 'Street �1 <br /> e. sxeet it nit 5 <br /> c� <br /> 9. Skeet IJ <br /> I G <br />' ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I <br /> EC7 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST) <br /> CLEANUP SITE (LOP) C} FOOD FAGlLlTY 0 SOLID WASTE VEHICLE <br /> Cl DAIRY, <br /> OTHER CLEANUP SITE(NON-LOP) ❑ DOC,KENNEL PLANT <br /> UNDERGROUND TANK(MONITOR1NGIREMOVAL) 0 CHICKEN RANCH 0 pKG TREATMENT <br /> HAZARDOUS WASTE GENERATOR C3 FU USE <br /> TOILETS <br /> MITTED FACILITY la MOTELIHOTEL I. p LAND USE APPLICATION SITES <br /> ED PER OLlSPA <br /> TIER Q PO <br /> TATTOOIBODY PIERCING 0 OTHER(PLEASE SPEq�IFY) <br /> Q MEDICAL WASTE FACILITY <br /> above. Select the type(S) of filest from the ist above138 mya I eckin <br /> List up to ten addresses in the spaceMUST be selected. Fax 1. a filet e <br /> en P <br /> the appropriate boxes}. At least Y <br /> address indicated above. . I ointment for review will be confirmed <br /> 2 EHD will notify the applicant if any EHD files exist. An app P Plication. The fle! <br /> approximately five business days but no later than ten (i6 days Appointments should be scheduled <br /> will be held for a maximum of five business days for nevi w. App <br /> accordingly. <br /> 3 A file that is actively being worked on by <br /> fife O availmay able.n11 et be Immediately available for review. n' <br /> application may be submitted when 1 • 9 EHD staff at the expen <br /> Any file not returned in the same condition as released anit be require a$93 00 deposit prior to rev' <br /> 4. k <br /> of thea applicant. Future file reviews by the same apwlth EHD staff. <br /> P firmed <br /> *TENTATIVE appointment dates must be con <br /> 5. Applications received after 3:00 prn will be processed the next business day. <br /> B' I1 <br /> 1l TIME <br /> r <br /> FIRMED APPOINTMENT DATE :3 FAX tN1TtAt_s � <br /> PHONE <br /> E GDNFIRMED REVIEW DATE <br /> EWED - <br /> YES NO <br /> FX13 45-02-006 i _ <br />