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NOV. 17. 2004 9:31AM ""DOR EARTH TECH NO. 7908 P. 1 <br /> EHD LOG NUMBER <br /> IPAp ncEivEo _ <br /> SAN JOAQ[JI'i T COUNTY <br /> N 0 V 1. 7 2004 ENvjRoNmzNTAL HEALTH DEPARTN ENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> �.1�1UiR�1 �w1f�l HL � 468-3420 Fax: (209)464-0138 Web;ynnv.co.san-joaquin,caxis/ehd <br /> PUB1,1C RE CORDS RELEASE APPLICA T 101i <br /> APPLICANT: �� hkL'3;7' _ r BUSINESSIAGENCY: (_Dt or- <br /> ADDRESS: a5 a v�� ",54CiYG(t� $ru-,1.1. 1, 5-16,L4v, , (- -9-540(e <br /> PHONE: t-21_ c si FACSIMILE 401-7-34-0,536 <br /> TENTATIVE;APPOINTMENT DATE:_ 12-I3 /Z O0 4 Time: 1'00 AM <br /> (Ploasa allow 10 buslness days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-593. EE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> +. sed !5 o N. �'►�c l a r city SA-0 v, ❑ Unit 1 <br /> 7. spa go Mom: city <br /> 3. sYeei 10 3 O S. (::)l'Vg Glv �tlnit 2 ^I <br /> 4. $vent 0 �. �v a—,V%111I -- G — 1 f <br /> 6. SbId 100 0 00't Y_ C <br /> � <br /> e. spa o di <br /> 7. sra 52 E . Mair, GI Unit . <br /> 6 sues. 5 055 e. aty <br /> e. sine 51 l (, Mctiin GI ❑ Unit 5 <br /> 10. Slreel 9�` <br /> Z'�2 (VLrA i vt •V 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ��v� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑❑ HOUSING ABATEMENT <br /> MENT 13501.111)WASTE FACILITY <br /> 1)WASTE VEHICLE <br /> V:OTHER CLEANUP SITE(NON-LOP) <br /> 0 UNDERGROUND TANK(MONITORINoiREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> �gC HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> PC TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> G TATTOO/BODY PIERCING ❑ POOL/SPA `3�LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O 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 boy(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 notrfy 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 fila;that Is actively being worked on by EHD staff may not be immediately available for raview. 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 f=uture file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> g. *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 /> :�.6��1������';Ap•�1�)�TIVI,l=i11�;D�7� ;' �``)'�11�>�.' , . .i• ; ' <br /> ,�; ';�; ., 'Pip' •,� ,i,E ��;1A�b'�17E' ,1 . ., .,,, i <br /> ��aaorooe . <br /> eiersaas <br />