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04/06/2005 09:56 FAX 209 9480 -' a 002/002 <br /> DATE RECEIVED SAN J•OAQULN COUNTY <br /> DEr"D!/DD ENVI,RONNSENTAL REALU:i DEPARTN ENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> 6 ?QW09) 468-3420 Fax: (209) 464-0138 Web: www.co,sm-joaquin.ca_us/ebLd 16N7 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> Gl11^ <br /> APPLICANT: 7;�xxn 7U,, 51� EUSINESSIAGENCY: I <br /> ADDRESS: <br /> PHONE: ~ 134 —FACSIMILE: 8 <br /> TENTATIVE'APPOINTMFNT DATE:_ Time: <br /> (Please allow 10 business days from date of application submittal) <br /> 13 CHECK BOX TO EXPEDfTE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 7l� <br /> DnpartnentUse Only <br /> FILE ADDRESS UNIT <br /> s.,d q325 j. W i S a ❑ Unit 1 <br /> z limo 410440 G N <br /> a " q_0 <br /> 5 <br /> �. saes 1 a' Unit 2 <br /> s. sreet 6zw �` Unit 3 v <br /> s '9431 <br /> T. sweet17v Unit 4 <br /> n -- <br /> �, sates Ob !R- Av-e <br /> 9. saert ; a Ra� c " L ❑ Unit 5 <br /> to. Sam <br /> J t ac� n <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE Ii-C)P) Q HOUSING ABATEMENT UL SOLID WASTE FACILITY <br /> OTHER CLEANUP SrM(NON-LOP) ❑ FOOD FACILITY C1 SOUO WASTF VEHICLE <br /> ®' UNDERGROUND TANK(MONffOluNG/REMOVAL) ❑ DOG KENNEL IS-DAIRY <br /> t{pZARpOUS WASTE GENERATOR Q CHICKEN RANCH �-PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACIE R CI MOTELIHOTEL ❑ FUM PER TRUCKJYARDICHEM TOILETS <br /> ❑ TATrooIBOOY PIERCING 17 POOL/SPA M LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILFY ❑ 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 box(es). At least one file type MUST be selected. Pax 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. Ane <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will he reorganized by EHD staff at the experts <br /> of the applicant. f=uture file 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 /> TIME }�:K: . :�,•s':°r <br /> CONFIRM�1].APPOINTMENT`-BATE - �:" }�•, <br /> DATE CONFIRMED <br /> 'L`PHONE FAX '%1Nff1ALS <br /> REVIEWED YES NO REVIEW DATE <br />