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APR_29._2004 3:35PM W,' STONE ENV. 714-414-1166 NO. 94240""P. 2/2"' <br /> :5A1N J1JAk2U11v i.vilNTY <br /> L ENVIRONMENTAL TRALTH DEPARTMENT E <br /> 304 E Weber Ave 3 Floor Stockton,CA 95205 <br /> PSR 2 9 2( >468-3420 Fax: (209)464-0138 Web: www.co.sanjoaquin-ca-us/ehd <br /> JE JVIROPJNIE�UT HtALTN UBLIC RECORDS RELEASE APPLICATION <br /> F i s` <br /> APPLICANT: r1s+��'� ✓L SUSIN£SS/AGENCY= 10 <br /> ADDRESS: ^ c <br /> PHONE: )�'`� ��I Z FACSIMKE -71'1` `) <br /> TENTATN€ APPOINTMENT DATE: <br /> rime: <br /> (Piano allow 10 busiraw d90 from date of application submMal) <br /> a CHECK SOX TO EXPEDITE FEWEST- 0-00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICA �Use Only <br /> ;nift <br /> FILE ADDRESS <br /> �r_,T"f R `� 5 L[] <br /> 4. strew -^^ 11 11 noAIWA -71 <br /> CAYD <br /> Me nit 4 <br /> c <br /> 7. Strep. <br /> e• sved ❑ Unit 5 <br /> e. 9rvw <br /> ,o. Fuee� <br /> c <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> O HOUSRlG ABAFT j3SOuo WASTE FACILITY <br /> d UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E3 FOOD FACWTY ❑ SOLID WASTE VEHICLE <br /> Id OTHER CLEANUP SITE(NON-Lop) ❑ DAIRY <br /> OWL- <br /> d UNDERGROUND TANK(MONfTOWNGIREMOVAL) [3O6 FACII❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> W HAZARDOUS WASTE GENERATOR ❑ CHICK N RANTEL G PUMPER TRUCIUYARNCHEM TOILETSaj <br /> ❑ TIERED pEPoyITT7D FAM" t2 POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PIERCING1 c3OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY -74 <br /> 1. List up to.ten addresses in the space above. Select the type($)of flies from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Eax to Q9211§100-0-r maims e <br /> address indleated dboVe• intment for review will be confirmed <br /> 2, EHD will notify the applicant if any EHD files exist. An appo application.receipt of The s <br /> approximately five business days but no later than ten(10)days aft8l fileeltts should be scheduled <br /> will be held for alMaximum of five business days for review. Appo <br /> accordingly. <br /> 3. A file that is a being worked on by€HD staff may not be immediately available for review. Anew <br /> application may be submitted when the file Is available. reorganized by EHD staff at the expense <br /> 4. Any file not retuinW in the same condition as released will m reorrguani ire a 93.00 deposit prior a review. <br /> of the applicant. Future file reviews by the same app Y <br /> 5. TENTATIVE appointment dates must be wrifirmed <br /> With the HD staff- <br /> business day. <br /> 6. Applications Mc ived after 3:00 pm will be processed <br /> CONFIRMED APPOINTIIAENT DATE TIM€ <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> „°°° 5,6-o�c; u e? Oa U,v>G LIZ 0�Lt,b S—s <br />