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�O1/07/2004 WED 14;30 FAX 2002/002 <br /> r i LUU4 14.roc 4c _-DO r-NVIKUNM-N l AL rVCHL I h t-AUL 01 <br /> DATE RECEIVE1b thu Lw nucwv�r. <br /> SAN JOAQMN COUNTY <br /> Vi' <br /> II��It� i,_' i' <br /> l_ ENVIRONNTENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> JAN 0 7 200 (209)458-3420 Fax: (209)464-0138 Web;www.co.san-jQaquin-Caus/ehd <br /> ENV1R0" i,1t:N i i-LmL—I i1 PUBLIC RECORDS RELEASE APPLICAnON <br /> APPLICANT• �O,y1 '/� BUSINESSIAGENCY• J�✓K /T-55DCIA%E.S <br /> ADDRESS: //7 "V-" ,57866r, „E,4i<&RSFIE(� t CSE <br /> PHONE:,1E?ty l) 0�7`��7/ � It FACSIMU:f n <br /> TENTATNE-AFPOINTMENT DATE; �/`3/O S/ Time:_�f z ell - <br /> (Please allow 90 buslnass days from date of application Submittal) -T wla- GN <br /> . S;�N r� <br /> \,T CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS 1��� _p�1�a <br /> SAA <br /> IGNATURE OF APPLICANT DATE <br /> Department Use Oniy <br /> FILE ADDRESS UNIT <br /> �Xe, OS4/Avy Unit 1 <br /> z ct 005 V c <br /> a sired Av 1 l Un)t 2 <br /> ,. street Da v -PR, a 4J <br /> s• suc� x500 NAfj /7% ❑ Unit 3 <br /> ytlf PR ch <br /> strcm / G <br /> �/e- E 1;115 �q5 <br /> I Unit 4 <br /> e. sty S D zit TON V s- <br /> nit 5 <br /> 9, sued <br /> C <br /> ENVIRONI(ENTAL HEALTH DEPARTMENT FILES � t <br /> l� ERGROUND TANK(UST)CLEANUP SITE(LOP) U >totJSRiG ABATEMENT M SOLM WASTE FACIL <br /> OTNER CLEANUP SITE(NON-I-OP) Q FOOD FACILITY SOLD WAS VEHICLE <br /> 0 UND1rRGROUND TANK(MONrrOR1NC4REL'OVAL) Q DOG KENNELp M DAIRY <br /> o HAZARDms wASTE GENERATOR 0 CHICKEN RANCH PKG TRI<A7MENT PLANT <br /> D TIERED PERMITTED FACILITY 0 MOTELIHOTEt ❑ PUMPER TRUCKfYARDlGHEM TOILETS <br /> t3 TATTOOnJODY PIERCING O POOU3PA 0 LAND USE APPLICATION STIES <br /> 0 MEDICAL-WASTE FACOJTY O OTHER(PLEASE SPECIF`D <br /> 1. hpta P to ten <br /> boxes) Ataddresses in e least Done fie space le typ MUSTthe <br /> be selected.f Ffiles <br /> ax t from <br /> the <br /> list <br /> 464-0138above <br /> o tri Checking <br /> PP <br /> address Indicated a Ove- <br /> 7- EHD will notify the applicant if any EHD files exist. An appointmentt for receipt reviewll bePlido confirmed <br /> files <br /> approximately five business days but no later than ten(10)days fter after <br /> oof should be scheduled <br /> will be held for a maximum of five business days for review. Appointments <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediatelyavailable for review. A ne' <br /> application may be submitted when the file is available. <br /> 4, Any file not returned in the same condiUorl as released will be reorganized by RHD staff at the expens <br /> of the applicant Future file review,by the same applicant may require a$93.00 deposit prior to revie <br /> 5. *TENTATIVE appointment dates must be confirmed with FHD staff. <br /> 8, Applications receiyed after 3:00 pm will be procBSSed the next business day, <br /> CONFIRMED opOINTMENT DATE TIME <br /> 1)ATE CONFIRMED <br /> PHONE FAX" INMALS <br /> REVIEWED q. YES NO REVIEW DATE <br /> EHD,a-a2-aaa . <br /> uertnos <br />