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1/22/2004 14:34 FAX 209 9480� U002/002 <br /> EC <br /> EIY <br /> Df�CC:-R <br /> �'l lenv. <br /> i`:;I '!� i'J SAN JOAQUIN COUNTY ,.....,". <br /> EN MONIYx.ENTAL HEALTH DEPARTMENT <br /> NOV 2 2 2004 304 E Weber Ave Yd Floor Stockton, CA 95205 <br /> Ei�(VIROJJMENT <br /> 468-3420 Fax: (209)464-0138 Web:www.co,saujoaquinx-a-us/ehd 0 <br /> PERMIV/CERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT: �v. }� /o�jivS BUSINESS(AGENCY: AlefoAlA.- <br /> ADDRESS oS <br /> PHONE:��°1`1$ ����5 FA(;SIMILE; O�A9/ 9`�1� -- <br /> . <br /> TENTATIVE'APPoiuTMEW DATE: la(3 nate. 1 •a 7 <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK 60X TO EXPEDITE REQUEST-39300 ME—REQUEST PROCESSCO IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT C / �S'�S DATE <br /> D;partment Use Only <br /> FILE ADDRESS UNIT <br /> S <br /> 1-750 lfAQM t1J6TDb3 lt-OAQ py lrocoMl r 0 Unit 1 <br /> 2. sunet o <br /> s. ( AC a oelf rs 7Unit 2 \3 <br /> <- s V' ��- <br /> s- Suck 4yys 9 Ls leer wo 0 a u T nit 3 <br /> 6- sura L r 'ti o f a 5 8 st'1 I l/ <br /> 7. Soper �J a o t nit <br /> 6- se-ea `1400 �"� t•' 8a J STo [- ,�`'.:> t-'. )`� •j _ <br /> a- sure aty Unit15 <br /> to. super <br /> City <br /> -ENVIRONMENTAL HEALTH DEPARTMENT FILES N <br /> UNDERGROUND TANK(UST)CLEANUP srm(LOP) p HOUSING ABATEMENT I.50U0 WASTE FACILrrY <br /> OTHER CLEANUP SIT>=(TION-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> Qi3, UNDERGROUND TANK(MONITORINGMEMovAL) 0 DOG KENNEL 19�DAIRY <br /> Z HAZARDOUS WASTE GENERATOR O CHICKEN RANCH S•-PKG TREATMENT PLANT <br /> O TIERI=D PERMITTED FACILrrY ❑ MOTELIHOTEL ❑ PUMPERTRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOUSPA M 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 tiles 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 ne• <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same Condition as r©leased will be reorganized by EHD staff at the expens <br /> of the applicant. Future rite reviews by the same applicant may require a$93.00 deposit prior to revie <br /> 5• 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6, Applications received after 3:00 pm will.be processed the nextbusiness day. <br /> .G0NFAF4MFD APPOlNTM1=NT'p ,H.:.., <br /> ATE' „f•t^; -:u TIME kid: ++:•'_ 1i <br /> "pATE•CONF.IRMEI] `"'� OrIE <br /> .REVi.EWED YES NO REVIEW DATE' ' :.: ... <br /> 8N01642-006 <br />