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Aar . 21. 2004 1 :05PM �eil 0• Anderson & Assoc , No•4929 LIP • 2 NIJNI'L . DATE rta uivCu SAN JOAQUIN 'COUNTY • d ENVIRONMENTAL HEALTH DEPARTMENT �U 304 E Weber Ave 3rd Floor Stockton, CA 95205 (209)468-3420 Fax: (209)464-0138 Web: www.co.sanjoaquin.ca.us/ehd I "7 XV APR 2 7 2004 I IPBLIC RECORDS RELEASE APPLICATION APPLICANT._` I'[7 / r-O '•' BUSINESSIAGENCY: r `�I (� • -rr�olxnSSv1 +" �SSdC ADDRESS: 9 0 Z 'Y10��15�+�1 IAp , t-')00 PHONE: 3(o -3-_N FACSIMILE: TENTATIVE'APPOINTMENT DATE: �I I I ID Time: 60 (Please allow 10 business days from date of application submittal) CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT ��t- DATE Department Use Only FILE ADDRESS UNIT 1. SveC 370 /' r�N /� cit 6 0 Unit 1 2. Skeet -3i-z4 VGW�/hL rTYt cay S ]. Saeel 0 'i 4. Y t t IU✓1 /S�� t L t �^ E] Unit 2 <. saeN I S. �)•VC 1" V2• G (�Vl or'� s. streai 440 E . fYl -17 S • of S-4-bel lsn Unit 3 h) 6. Saeei G o Unit 4 e. S Teat Q ty 9. SIreN el El Unit 5 10, sl' eO d ENVIRONMENTAL HEALTH DEPARTMENT FILES UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY IA OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE 0 UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKlYARDICHEM TOILET ❑ TATTOO/BODY PIERCING ❑ POOLJSPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) — 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checkii the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to th address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The file will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A r application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the exper of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to rev 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. E RMED APPOINTMENT DATE TIME NFIRMED PHONE FAX INITIALS ED YES NO REVIEW DATE Eno 4a424oz aano0]