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06/25/2004 13:52 2094671118 AGE STOCKTON PAGE 01/0 <br /> DATE RECEIVED, _ • • EHD LOG NUMBER <br /> '� (-��s�V�` �1�i SANJOAQumlCourrTY <br /> " `� -'II 1`� ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUN 2 5 20 304 E Weber Ave 3d Floor Stockton, CA 95205 <br /> 09)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> ENVIRUNPf ENT HEHETH PUBLIC RECORDS RELEASE APPLICATION <br /> r F <br /> SF <br /> APPLICANT: - BUSINESSIAGENCY: <br /> ADDRESS: oa <br /> PHONE: ,07/�` FACSIMILE: <br /> 0707�} �� <br /> 1 r1� TENTATIVE*APPOINTMENTDATE: [(�E�IJ. 3D,�Un,e Dhea: .06y Tar <br /> G�� Sooner ��c <br /> �� f yE>VI (Pbaso allow 10 buslnoss days from data of application submittap ad� <br /> 14� <br /> CHECK BOX TO EXPEOITF REQUE - 93.00 FEE-RE UEST PROCESSEDN� / <br /> 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 4 SOI a) 7 C CC DATE <br /> Department Use CrIV <br /> FILE ADDRESS UNIT <br /> 1. S"m 4CC Unit 1 <br /> 2. S"at C /L� in <br /> e. s"M p <br /> .. street C490 <br /> 71 <br /> e. svex _ <br /> Unit 3 <br /> r, street a Unit 4 <br /> Oy <br /> e. Stteet <br /> nl 5 <br /> o. sveeCRY <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �n <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 171 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE _ <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY ` <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> 4 TATTooIBODY PIERCING ❑ POOLISPA �K 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(as). 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 /> Pit <br /> CONFIRMED APPOINTMENT DATE TIME T 3a <br /> DATE CONFIRMED PHONE FAX fNfhAL§ '_ <br /> REVIEWED YES NO REVIEW DATE <br /> i;1W; _" <br /> NI;009 <br />