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n u• LVV`t L;J3rivi W1VjUI( tANI i 1t�7 NU. 1141 r. 1 <br /> Dni n,w�rw --OGNUMBE <br /> SAN SOAQMN COUNT TY A r- 0 7 2004 <br /> V1R0`I1WNTAL HEALTH DEPART. T <br /> -' 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> APR 0 6 2004 (209)468-3420 Fax: (209)464-0138 Web:www.co.san joaquirn.ca_us/eh <br /> EV1F'ii�>.''. ; � j­1 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: (%NZ_A L�ZOUSINESS/AGENCY: d 01v 1z_ <br /> ADDRESS: <br /> r� rk-,9 N K w 6��—I - <br /> PHONE: ( 7 50ItFACSIMILE -- D - <br /> zz,3z. <br /> TENTATIVE*APPOINTMENT DATE: ez A przjL— Q�_Time: 0 <br /> (Please allow 10 business days from date of applicatlan submittal) <br /> CHECK BOX TO EXPEDITE RE -$93.00 FEE-RE VEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 'f DATE Q l <br /> Deparbnent Use Only <br /> FILE A.ODRESS UNIT <br /> s R4Nr 41N6 Ra. CM .N e_ ❑ Unit 1 <br /> 2. Shea '? q 5 1 p <br /> 3. Sve t -7 QFj5 <br /> �' Unit 2 <br /> 4. sveI( '? 'Li 71 4gol 1 <br /> s. sweet �{8'S Unit 3 <br /> s. s OI a <br /> T. 51rw a nit 4 <br /> e. Slraet d <br /> S. S. $ZZUty <br /> ❑ Unit 5 <br /> io- succi ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(U"CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY k SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 414'DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY M MOTEUHOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOISODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> �d MEDICAL WASTE FACILITY ❑ OTHER(PLLASE 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. 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 new <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 /> DATE CONFIRMED PHONE . FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 4a42-M6 <br />