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U002 V <br /> 10/28/2004 13:24 FAX 209 94800 <br /> DA RECEIVED SAN JOAQUT.N COUNTY <br /> ENyMONMENz'AL HEALTH DEPARTMENT O <br /> 304 E Weber Ave 314 Floor Stockton, CA 95205 <br /> 209 468-3420 Fax: (209)464-0138 Web'WWW-O0.san joaquln.ca u.'ehd 2 <br /> PUBLIC 12ECORDS RELEASE APPLICATION <br /> APPLICANT: FV,,, BUSINESSIAGENCY: ,"2`�" - <br /> ADDRESS: a� <br /> 1Mir-Ilo �+•� `r-�a�kbn � r�o'td� - <br /> FACSIMILE; <br /> PHONE: <br /> TENTATIVE`APPOINTMENT DATE: UP' <br /> / /a-' _Tbne: <br /> 1Zla— <br /> (Ploasa allow 10 business days from dale of application submWMI) <br /> CHECK BOX TO EXPEDITE REQUEST.$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS I <br /> 1 ���• _ DATE <br /> SIGNATURE OF APPLICANT Y <br /> 0eoarAnent use Only <br /> &* <br /> NIT <br /> FILE ADDRESS , d"�, � _ <br /> i- Unit 1 <br /> z. srK+ ra k �,. Unit2 <br /> . .:��"r:e.' �\off <br /> L10 v rvea � ..� Unit3 1� <br /> sk+ 3 CZo c L ( r; / <br /> 6. Saes I{CO �—�` -' 6 P t • Unit 4 <br /> 7. Sand E O e¢ <br /> sued t Gt /'- .J . ,. ❑ Unit 5 <br /> ./svea qK5 C>4 rt, .:�,`1 �•,, 1�J1. <br /> CRY <br /> w G itM <br /> ENVIRONMENTAL 14EALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT In SOLID WASTE FACILITY <br /> J$ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O 0000 FACILITY E3AIRY WASTE VEHICLE <br /> D <br /> S OTHER CLEANUP SITE(HON-LOP) d DOG KENNEL DAIRY <br /> IA UNDERGROUND TANK(MONFTOmNGlREMOYAL) 0 CHICKEN R 0.ANCH PKC'TREATMENT PLANTHEM TOILE fS <br /> IS HAZARDOUS WASTE GENERATOR ❑ MOTEVHOTEL 0 PUMPERTRUCKIYAROIC <br /> r3 TIERED PERMrrrED FACILTTY E3POO�PA LAND USE APPLICATION STTES <br /> ❑ TATTOOBODy PIERCING ❑ OTHER(PLEASE SPECIF'r) <br /> 0 MEDICAL WASTE FACILTTY checking <br /> 1 List up to ten addresses in the space above. Select tho types) of files from the list above by <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (20 91 464-013 8 or mail to the <br /> address indicated abo ie. y ointment for review will be confirmed <br /> 2 EHD will notify the aPP icant if an EHD files exist An aPp <br /> approximately five business days but no later than ten (10) days a^ gets files <br /> $hauidpbe scheduled <br /> will beheld for a maximum of five business days for reviow. App <br /> accordingly. not be immediately available for review. A new <br /> 3. A file that is actively being worked on by EHD staff may <br /> application may be submitted when the file is available. <br /> q, Any Fi{e not fetumed 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 593.00 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 /> ;::,•:. � ' :RIME H77,: <br /> ;DATE CONFIRMED '` <br /> YES NO REVIt=VY DATE: '-;:. ..:,. <br /> REVIEWED - <br /> ENO�MaAo4 <br /> yyjryJl <br />