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`—OI/07/2004 WED 14;30 F: n [ 002/002 <br /> tnU Lw nim W <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> RE� Ji! 'lyi' iF I % ENVIRONA'1ENTALREALTUDEPARTMENT � <br /> (rl304 E Weber Ave P Floor Stockton,CA 95205 / <br /> JAN 0 7 2004 (209)468-3420 Fax: (209)464-0138 Web:www,co•san-joaquin ca us/ehd <br /> cNVIRUNNit d-i HL, LkAl PUBLIC RECORDS RELEASE APPLICATION <br /> PERP,^I , <br /> APPLICANT: ��iYl """� BUSINIESS AGENCY: <br /> ADDRESS: /// r,V/ It S62T -- <br /> PHONE: I _ (7 FACSIMILE- <br /> TENTATIVE-APPOINTMEWDATE: ' —Tkne:—/;��/r! <br /> T GJIGL cN BE //� <br /> ,�� �" (Plea9e aI1mY'10 bU51ne39 days frgn date of aCPe�°n SUEmittafi so�DN rUcsDhY <br /> L CHECK BOX TO EXPEDITE REQUEST-S93,ee FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT DepanmentU"Only <br /> UNIT <br /> FILE ADDRESS <br /> DSK $TOC D ❑ Unit 1 <br /> C� <br /> ODS AlAvyn/(2 ;e Unit 2 <br /> AUY " /- <br /> 03 RV ly <br /> s, s� d500 f�AV E3 Unita <br /> AV <br /> o. sv:er oZ0 / R, .7 02-95 C' <br /> r M M / ��/E LEt;I15 Unit4 <br /> e swd 8 D z�-TOiv V6 nit 5 <br /> 9. Sven <br /> 10. 3E+d G .. <br /> ENVIRONE(ENTAL HEALTH DEPARTMENT FILES <br /> t ERGROUND TANK(UST)CLEANUP SITE(LOP) O HOSING ABATEMENT C�sOt-ID WASTE FACILnY-- <br /> �NT� P FOOD FACILITY ❑ SOLID WAST£VEHICLE <br /> •R UNDER CLEANUP SITETANK <br /> (NON�AP) ❑ DAIRY <br /> • UNDERGROUND TANK GENERATOR <br /> M DOG KENNEL q pKG TREATMENT PLANT <br /> ❑ HA2ARD ER ITTED GENERATOR O CHICKEN RANCH <br /> O TIERED PERMITTED FACILf77 ❑ MOTELIIIOTEL ❑ PUMPER TRUCKNARDICHP.M TOILETS <br /> • TATTOOMO Y PIERCING O POOLISPA O LEND USE APPLICATION SIr£S <br /> 13 MEDICAL WASTE FAGIUTY O OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list aboye by checking <br /> the appropriate box(es)- At least one file type MUST be selected. Fax to 209 464-0138 or mil to the <br /> address Indic ed 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. Appolntments should be scheduled <br /> accordingly. <br /> 3. Afile that Is actively being worked on by EHD staff may not be Immediately available for review. A neo , <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 expens <br /> of the applicant- Future file reviews by the same applicant may require a$93.D0 deposit prior to revie <br /> 5, "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> s, Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMEDPOINTMENTDATE TIME - <br /> �DATE CONFIRMED - PHONE FAX 'INMS <br /> REVIEWED •, YES NO REVIEW DATE <br /> El1D{bY3-006 .•_ <br /> �IeflWa <br />