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v <br /> o,CEC._2_2003 2:54PM V 9OR EARTH TECH _ N0: 1619 P. 1 <br /> �s SAN JOAQUIN COUNTY EHD LOG NUMSE, <br /> ENVI oNwNTAL]hA.LTH DEPARTMENTr <br /> i_1::_� ti��Ji;.'jr1EAl-. <br /> qq l`�.�7 ? rtl. 111 <br /> 304 E Weber Ave Yd Floor Stockton, CA,95205 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.co.san joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION 03 DEC -2 Phi 3: 42 <br /> APPLICANT:p / �� � �, L BUSINESS/AGENCY: b0 j} ��F-7" <br /> ADDRESS: Sr `^Toc io <br /> PHONE. FACSIMILE: -- Q S7 3 <br /> TENTATIVE*APPOINTMENT DATE: _ �m Time. <br /> (Please allow 10 business days from date of application submittal) <br /> I <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE �3 <br /> Department use Only <br /> FILE ADDRESS 'r UNIT <br /> t. s O f S a U <br /> - Street , N u r r' N n' <br /> nit25. 1v <br /> G sve�W G <br /> I's <br /> MON ragh five35a6 <br /> e. sv Y°13 S G C751 <br /> m 111t4 <br /> 9. street 3 aq pWqQ <br /> Ia. streat 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(US-)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ­ CI FOOD FACILITY SOUD WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL C] DAIRY <br /> HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> Vr TIERED PERMITTED FAcii rry ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOOISOUY PIERCING ❑ FOOLISPA ❑ LAND USE APPLICATION SITES <br /> ME'b1CAL wAsw FAcn.ITY ❑ OTHER(PLEASE SPECIM <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. f=uture 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 INITIALS <br /> REVIEWED YES NO REVIEW DATE' <br /> EHo 44.92-c" <br /> GL 7u, <br />