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01/09/2005 23: 47 2093699 STEPHEN G.MUIR PAGE 02/02 <br /> DATE RECEIVED 1 EHD LOG NUMBER <br /> AN JO A.QUIN COLTN'A'v <br /> ENNIRONNIEN'FAL IftALTH DEPARTMENT <br /> ?^4 F 1Vebe.r Avp ""d Floor. Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209)464-0138 Web: xvww.co.san-joaquin,ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1"tV 110 _ _ BUSINESWAGENCY: 'G /tf v i CO-J ,�- Ge-010 <br /> ADDRESS: 4�dwPC'/� SQ C /�N WC10D�•�/D <br /> PHONE: / Y-3� r `�� FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: O TarrK; <br /> (Please allow 10 business days from dato of application submittal) <br /> ri CHECK ROX TO EXPEDITE REQUEST- 3.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE //"o ho <br /> Department Use Only <br /> rW- Froorie /lAq FILE ADDRESS UNIT�� <br /> 7 . c Sj OCI- a/ p Unit 1__. <br /> 2, strmot c <br /> 3. street city d Unit 2 <br /> a. sure <br /> 31 street c ❑ Unit 3 <br /> B. st, CKV <br /> 7. mo'"W CKY CI Unit 4 <br /> a. sweet cay <br /> 9. 9troo <br /> © Unit 5 <br /> 10. Bneet Cny <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> O UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT In SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY b SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR n CHICKEN RANCH n PKG TREATMENT PLANT <br /> ❑ T11=RED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> n TATTOO/BODY PIERCING ❑ POOWSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY fn OTHER(PLEASE 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(ea). At least one file type M UST be selected. Fax to 9464-0138 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 /> a.........:...p..ti.4n.n b ts;.,,.��dpys bi,t no later than ter, (1 1)days after receipt of application. T'rle riles <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 reviows by the saltie 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 /> END AB-02-M <br /> eienoo3 <br />