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u� p1�: r (THU) SEP 16 2004 13:43/ST. 13:42/No. 6812855736 P <br /> RtLCE1VED EHD LOG NUMBEI <br /> SAN JOAQUXN COUNT' <br /> SEP 16 2004 ENVIRONMFNTAL HEALTH DEPARTMENT <br /> ENVIRON1[VI EPi T 'tit <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> PERN11 i;-SERVIC )468-3420 AX: (209)464-0138 Web:www.co.san-joaquincaus/ehd <br /> a00V <br /> pUB►LIC RECORDS RELEASE APPLICATION <br /> APPLICANT: SLeUG �ea toy1 BUSINESSIAGENCY: C¢ny���G Ca�su� tr <br /> ADDRESS: 103,71 r(/G <br /> PHONE: 6l - 79 - QS4 FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: / � 1� Time: <br /> - dui <br /> lease allow 10 business days from date of application submtdal) / <br /> C3 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PRO ESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE mw/o y <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> ✓�/✓ �. s 3 ht/17i'� ci,, p Unit 1 <br /> 2. sveN Z '::�A 7 <br /> „ n n r� ❑ Unit 2 <br /> 5. 3veet <br /> li Unit 3 <br /> 6. Street <br /> so.« cny n 4 <br /> e. 3tred <br /> Oty <br /> Cry n' <br /> a SV” G ❑ Unit 5 <br /> tio, sveet <br /> J4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CL UP SITE(LOP) 0 HOUSING ABATEMENT "l a�WASTE v Gr1►c� <br /> OTHER CLEANUP SITE(NON-LO ) 0 FOOD FACILITY <br /> i�UNDERGROUND TANK(MONITO,3JNGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHIGKEN RANGH 0 PKG TREATMENT PLANT <br /> O TIERED PERMrrIED FACILITY ❑ MOTEL HOTEL ❑ PUMPER TRUCKNARDICHEM TOILETS <br /> ❑ TATTOO(BOOY PIERCING C3 PA C1LAND USE APPLICATION BITES <br /> ❑ MEDICAL WASTE FACILITY OTHER(PLEASE SPECIFY <br /> 1, List up to ten addresses in the space above. Select the types)of files from the List abode by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 X46"138 or mail o the <br /> address indicated above. <br /> 2. EHD will notify the pp can 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 fora maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is active y being worked on by EHD staff may not be immediately available for review. A neM <br /> application may b 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. F uture 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 recei ed after 3:00 pm will be processed the next business day. <br /> =REVIEWEDYES <br /> NT DATE TIME <br /> 'PHONE FAX: INITIALS <br /> NO REVIEW DATE <br /> EHD4"Z-Q% <br /> ersrzoo3 <br />