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MAY. 18. 1004- 2: 08FM NTGOMERY WATSON NO, 923EHDLp 1UMBER <br /> DATE RECEIVED SAN JOAQULN COUNI Ty <br /> IP. <br /> \1 ELDj E+I�ONMI✓NTAL HEALTT�DEPARTMENT <br /> 304 E Weber Ave 3rd door Stockton,CA 95205 <br /> MAY 1 8 2 69)468-•3420 Fax,• (209)464-0138 Web: v,w-W.co.san joaquin.ca.us/ebd <br /> ,JPdMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> pi:C;r•;1 T . rl <br /> APPLICANT: v <br /> r BUSINESSIAGENCY: <br /> ADDRESS: LjP"` 6✓1 L <br /> PHONE:� b1 Z-�� ag�•�{ <br /> FACSIMILE: <br /> Time: <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Please allow 10 business days from date of appReation submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-593,00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS /� <br /> PATE <br /> SIGNATURE OF APPLICANT t�p','n ntuseonly <br /> UNIT <br /> FILE ADDRESS <br /> t, s et BOO er,.�� C ��OG� D✓� a ❑ Unit 1 <br /> G L <br /> z. s• IS L Unit 2 <br /> 3 <br /> Unit 3 ���� <br /> d <br /> o \ C, <br /> s, street z Unit <br /> City, <br /> 7. west i-7 O op <br /> c. <br /> g, sweet Unit 5 <br /> 3-� o <br /> 9. S et 9 <br /> o, sUeet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> J( UNDP.RGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOUD WASTE VEHICLE <br /> 0 OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL M' DAIRY <br /> It UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> �( HAZARDOUS WASTE GENERATOR ❑ CHICKMOTEEN <br /> RANTEL ❑ PUMPERTRUCKIYARD/CHEM TOILETS <br /> Cl TIERED PERMITTED FACILITY C1pooUSPA ❑ LAND USE APPLICATION SITES <br /> Cl TATTOO/BODY PIERCING ❑ OTHER(PLEASE SPECIM <br /> ❑ MEDICAL WASTE PACILl'" <br /> 1, List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> ) 209 464-0138 or mai{to the <br /> the appropriate box(es). At least one file type MUST be selected. Fax t <br /> address indicated above. for review will be confirmed <br /> 2• EHD will notify the applicant if any EHD files exist. to appointment10 days after receipt of application. The files <br /> approximately five business days but in later than ten( y ointments should be scheduled <br /> will be held for a maximum of five business days for review. App <br /> accordingly. <br /> 3. A file that is actively being Worked on by EHA staff may not be immediately available for review. neµ <br /> application may be submitted when the file is available. reorganizedbe b EHD staff at the expense <br /> a• Any file not returned in the same condition released li will may require a$93 00 deposit prior to review <br /> of the applicant. Future file reviews by the same <br /> me app <br /> th EHD staff. <br /> 5• *TENTATIVE <br /> appointment <br /> dates pm will must be be processed it a next business day. <br /> 6. Applications received <br /> pm <br /> VI fY111, �' RI?CIell <br /> NTjIIEt�1TleuT>G :...,r. ;,f. ..y /' •'Li /�, r •,�,•,: • . . J'JrL00 <br /> 4ZL'. ^ 'r, <br /> DATE OdNFiRNI>+p ,r <br /> RE CM r"�,�f�. ;• <br /> ��TE <br /> REVIEW DU Y1*$ ;"" Nv " u• <br /> EHo 43-x2.006 <br /> 9!92003 <br />