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h ---I L'rlD LOG NUIODC1t <br /> ilitow-eyou SAN JOAQUIN COUN'ry <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> U'J <br /> 2 0 2007 304 E Weber Ave 3" Floor Stockton, CA.95205 <br /> ENVIE ! 1ENT HEA )468-3420 Fax (209) 464-0138 Web: w,vw.co.san-joaquin.c3s; <br /> hd <br /> P � iUiIT/SrfiV10E PUBLIC RECORDS RELEASE ,APPLICATION <br /> APPLICANT: rl �r/ — BUSINESS/AGENCY: /v Pit I �� Ail MAsen + A-fco< (t1c <br /> ADDRESS: <br /> PHONE: 3V- ^ 3 J-D \ FACSIMILE: <br /> TENTATIVE*APPOINTMENT C�DATE: ,` f "a 0 Time: I ' <br /> CFO <br /> (Please allow 10 business days from date Of application submittal) <br /> CHECK 130X TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Vse Only <br /> FILE AD KESS UNIT <br /> 1. Street -3g (A' N !�/I+V}'�{"� �I� � ❑ Unit 1 <br /> 2. Street 39'31 ,,p. ICS `P' ' Clt <br /> J. Streel :393 1 7' A] '�'�'"� Y� CII Lj Unit 2 <br /> 4. street 3�f U ,Pj,J� n Q' � � Clt <br /> 5. Street 3 eY , f t 4ql cit Unit 3 <br /> 6, Slrecl O �'r l/un VJ cit F <br /> 7. 51reel J27 c?-�i3-2- r/`r /\j 1Sa'c'v CI' - <br /> 8, . <br /> 9. Slrerl 0++,_,['(-�^�•• {/mil l ��a. CII jUnit <br /> 10. 5lrrrl 1k J J E:- G CII <br /> a. <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT CI SOLI <br /> OTHER CLEANUP SITE(NON-LOP) D FOOD FACILITY ❑ SOLID WASTE V CLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL.) I-] DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 1 TIERED PERMITTED FACILITY 0 MOTELIHOTEL. ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> El TATTOO/BODY PIERCING L1 POOL/SPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 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(es). At least one file type MUST be selected. Fax to (209)464-D138 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 /> 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. 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 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 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 /> EWD 40-02-005 - �. <br /> tjlBf200J ' <br />