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10/al/2005 09:51 FAX 209 9480E" Z002/002 <br /> vnD SAN JOAQUEY COL <br /> ENYMOWENTA.L HEALTH DEPApumiNT <br /> OCT n 11005 ' 304 E Webcr'Ave 3`d Floor Stockton, CA 95205 <br /> EtiVInG�i r�Ef l t� ,?��68-3420 Faz: (209) 464-0138 Web: www.co.san joaquin.ca us/ehd <br /> . ROY? 7 <br /> PER^V"!i�`�Ef,VICFS PUBLIC RECORDS RELEASE APPLYCA bN <br /> /IPPL 1C.4N7 BUSINESSIAGENCY:_ /<- <br /> 7 ST <br /> PHQNE:_7�� l' 3y -FACSIMILE; <br /> TENTATIVE*APPOINTMENT DATE: <br /> (please allow 14 businesS days from date of applicstlon submitiaO <br /> CHECK 80X TO EXP£D(TE REQUEST-P3.00 FEE—RE UEST PROCESSED IN]BUSINESS DAYS f <br /> SIGNATURE OF APPLICANT DATE <br /> Dtvarbwtnt Use OTW <br /> FILE ADDRESS UNrf <br /> ,. Unit 1 <br /> i, -1 City <br /> 1. suit {Q <br /> g Unit 2 <br /> 4, Skwd � <br /> D city AX fc, F, Unit 3 �ifCtJ <br /> sir=e( a <br /> 1 surd c— Unit 4 <br /> � sr� a*7 - EV7�� <br /> sCky Unit 5 <br /> io_ skcd . <br /> -ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(Us-r)CLEANUP SITE(LoP) ❑ HOUSING ABATEMENT IRL SOUD WASTE FACILCTY <br /> OTHER CLEANUP SITE(NON4-0PI O FOOD FACILITY ❑ SOUO WASTE VEHICLE <br /> I* UNDERGROUND TANK(MONiTORING(R£MOYAL) <br /> Cl DOG KENNEL & DAIRY <br /> Ise HAZARDS WASTE GENERATOR O CHICKEN RANCH Ili-PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELAHOTEL Q PUMPER TRUCKIYAROICHEM TatLETS <br /> ❑ TATTOO/BOO PIERCING ❑ POOLISPA = LAND USE APPLICATION SITS <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 mai[to the <br /> address indicated above_ <br /> 2. EHD will notify the applicant if any EHO 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. Anew <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. 'TENTATIVF-appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm wilt be processed the next business day. <br /> AT.EgN�.IRMED ' '�'.- PHONE . FAX' . FT � •'.�"'. <br /> REVIEWED YES NO PREVIEW DATE' <br />