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EHD LOU NUMtitK <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> rr�� ((,, I ' ENN .AONMENTAL HEALTH DEPARTh . ,NT <br /> LSI h V u IE F�� 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209) 464-0138 Web : www.co.san-joaquin.ca.us/ehd I <br /> FEB 0 9 2004 <br /> ENVIRuNM PUBLIC RECORDS RELEASE APPLICATION <br /> IT/SE �UfEES /� S'F eu ) ct S . T <br /> APPLICANT: "� � �n-+ /J / 'r �� BUSINESS/AGENCY: P ) e2 � � � `' - <br /> ADDRESS: <br /> PHONE: S 3O ZO -" f — FACSIMILE, <br /> TENTATIVE* APPOINTMENT DATE: Time: <br /> (Please allow 10 bust ss days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQU T - $93,00 FEE RE EST PROCE EDI 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> J DATE <br /> Department Use Only <br /> UNIT <br /> FILE DRESS <br /> 1 . so-eet 5c k/L'r/ �._ dfa A� ' E] Unit 1 <br /> 2. Street /4.; aty �— <br /> I a ❑ Unit � pp1l� <br /> 7. Street <br /> C4 <br /> 4. Street <br /> S. street G Unit 3 <br /> G <br /> 6. Street <br /> 7G Unit 4 <br /> . Street <br /> a. Street <br /> G <br /> 9. Street <br /> a ❑ Unit 5 <br /> C <br /> 10. Street <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1� UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> WOTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY E3SOLID WASTE VEHICLE <br /> Z UNDERGROUND TANK (MONITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY - <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ 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 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 files exist. An appointment for review will be confirmed <br /> approximately 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 /> 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 file 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX 1NITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> END 46-02-006 <br /> WWO03 <br />