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Ub/lb/U4 11'EU Ub:4U 1A1 916 :Stitt IU13 KLE1M'ELDEK �• �... •. •��•�� <br /> DP.TE RECEIVED SAN JOAQUIN COUNTY <br /> r�C� 1" '9 <br /> (� ENVIRONMENTAL HEALTH DEPARTME_ <br /> L 11�'% 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> JUN 1 6 2004(2)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/ehd <br /> EWRONiv^Ef,JT HFAITH PUBLIC RECORDS RELEASE APPLICATION <br /> PETIT/SERVIC�S Bus,NEssr,4cENCY: P s()}p�C]er �-IIC . <br /> APPLICANT: P YlYl1 ( ��� --— <br /> ADDRESS:03077 E' Q1 <br /> PHONE: (n(�)as o_ 1701 _FACSIMILE: 9��0 3(� <br /> 70 13 <br /> TENTATNAPPOINTMENTDATE:"LLC_����rne: <br /> (Please allow 10 business days from date of application submittal) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$93.00 FE REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE (41 o <br /> SIGNATURE OF APPLICANT Departrnent Use Only <br /> bi•ii i <br /> FILE ADDRESS <br /> ri. streeta '77 a — Untt 1 <br /> saw e_ <br /> sum 2 Unit 2 <br /> - da � <br /> .. StW I nit 3 1 <br /> s. Svee+ <br /> S. Street <br /> My unit 4 <br /> �. sneer <br /> e. stne! <br /> '7q7W (1 <br /> Sneed w <br /> C] Unit 5 <br /> 2 '\ f <br /> PEA <br /> o. I,srsa y'1 t5'1 T �fRN <br /> {�� �,�;91.�� '� t' " NMENTAL`�tEAL DEPARTMENT FILES <br /> lJ <br /> HOUSING ABATEMENT 13 SOLID WASTE FACILITY <br /> 9 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE L/ <br /> ® OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL ® DAIRY L <br /> IX UNDERGROUND TANK(MONITORINGIREMOVAL} ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 63 HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOBODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILr1Y <br /> 1, List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> e MUST be selected. Fax to(209)464-0138 or mail to the <br /> the appropriate box(es). At least one file typ <br /> address indicated above. intment for review will be confirmed <br /> 2. EHD will notify the applicant if any EHD files exist. An appo <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, '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 /> PHONE FAX- <br /> DATE CONFIRMED <br /> INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> .&won -0°` <br />