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02/22/2005 13:08 FAX 208 948062' 10002/002 <br /> Cnv wv + <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> Z1111� <br /> fJENVIRo NTA LFEALTH DEPARTmE,304 E Weber Ave 3 Floor Stockton,CA 45205 <br /> ' �-) <br /> � vj <br /> � 468-3420 Fax: �209) 464-0138 Web:www.co.san-)oagwn.ca.us(ehd <br /> ' 2005 PUBLIC RECORDS RELEASE APPLICATION <br /> � <br /> Lrf 1" " --- <br /> E r <br /> �t vii ; 13USLNESSIAGENCY: {` <br /> CAADDRESS: <br /> PHONE: FACSIMILE: -i"10 DCo 02� <br /> TENTATr,/E'AFFOm 7MENT DATE: IN": <br /> (please s11ow 10 business days from date of appricatien submittal) <br /> ❑ CHECK 60X TO EXPEDITE REQUEST-S93-00 FEE-REQUEST PROCESSED M 3 5USiNESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNrf <br /> L,u k0A0a ❑ Unit 1 <br /> i. s�n•e, <br /> 243o C <br /> ry <br /> G0.r� C L( QUAD c " Unit <br /> S' sreec a Unit 3 j l <br /> fi. Sir:el - <br /> Unit 4 <br /> T. 5-0reMl e° <br /> e. 50—M �3 <br /> 0 Unit 5 <br /> 9. SHeet <br /> 10, seed Gtv �' <br /> ENVIRONMENTAL HEALTH DEPART-MEN-1 FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE�FLrrySOLID WASTE VEHICLE <br /> OTHER CLEMUP SITE(NON-LOP) ❑ FOOD FACILITY d <br /> M UNDERGROUND TANK(MONITORINGIREMOYAL) ❑ DOG KENNEL. 19-DAIRY <br /> CHICKEN P'MCH 15L PKG TREATMENT PLANT' <br /> X HAZAROMS WASTE Gkhcrt,7 ti ❑ MOTELIHOTEL 13PUIMPERTRUC�ARD/CHEM TOILETS <br /> LT' TIERED PERMITTED FACILITY Ca LAND USE APPt1CATION SITES <br /> ElTATTOOIeO❑Y PIERCING ❑ PA <br /> O MEDICAL WASTE FACILMY r_1OOTHER THER(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. confirmed <br /> 2- EHO will notify the applicant if any EHD files exist. An appointment for review will eceipt of application. The files <br /> approximately five business days but no later than ten (10)days after r <br /> will be held for a maxir,�usr` o;five business days for review. Appointments should be scheduled <br /> accordingly. . <br /> A itie Bina,i.� u.-s ri ly ,� •. °'i�e1 by EHD staff may not be immediately available for review. A nev <br /> application may be submitted when the file is available. <br /> 4, Any file not returned in 'V--,e Same condition as released will be reorganized by EHD staff at the expensf <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to reviev <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications reCelved after 3:04 pm will be processed the next business day. <br /> CQNIRME . AP f -.7 71ME <br /> fHONEFAX " �= ~INtX1AL. <br /> 'DATE-f faNFIRMED <br /> 'REVIEWED YES NO REVIEW DATE,-` , <br /> ' PliO�II-02-006 <br /> ■ntnAol <br />