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Rug 20 04 08: 25a F •r s 408--0;59-1224 p: 1 <br /> DATE RECEIVED EHD LOG[NUMBER � <br /> _ SAN JOAQUIN COUNTY <br /> 6'� Ij VI'S ENV RONMTNTAL MALTA DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> AUG 2 0 2004 (209)468-3420 Fax: (209)464-0138 Web:vtmw.co.san-joaquin.ca.us/ehd <br /> 9!5 <br /> ENVIR, E - cc PUBLIC RECORDS RELEASE APPLICATION y <br /> PE A�PklIC NTvIriEJt'i7���4 !�{ �/f� --BUSINESsIAGENCY:,� lt E�O1r0/(/Y1Qy�.l"C�11 Zvi <br /> ADDRESS: CO^. U PP C�✓tL O �. C— I <br /> PHONE:,w[ _ C�—I � FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of appileation submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-593.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 75/J <br /> Department Use Only <br /> UNIT <br /> FILE ADDRESS <br /> C, '„ 4P� r fl1Ja'n ❑ <br /> � Unit 1 <br /> z. S1roet O E. - Sf <br /> ��� �.► u- 5 �r a� unit 24� <br /> s. st ee, 00� P �� <br /> 4. Sheet <br /> cn it 3 <br /> 5. Sheet <br /> Ch <br /> 6. street Unit 4 <br /> G• ' <br /> Z Street <br /> G010 <br /> � <br /> e. street Unit 5 <br /> c • <br /> S. street <br /> C� <br /> ia. Street <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP} ❑ FDOD FACILITY Q SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ DAIRY <br /> l UNDERGROUND TANK(MO NITORINGIREMOVAL) MENT PLANT <br /> ❑ DOG KENNEL d pKG TREAT <br /> .(7( HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH Cl PUMPER TRUCKIYARDICHEM TOILETS <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL C3 LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PIERCING ❑ A <br /> E3 MEDICAL WASTE FACILITY ❑ OTHER THER(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 209 484-0138 or mail to the <br /> address indicated above. Y ointment for revlew wits be confirmed <br /> 2, Ho <br /> wi11 notify the applicant if an EHD fifes exist An app <br /> approximately five business days but no later than <br /> an ten(ie days shoulapplication. <br /> be scheduled files i <br /> will be held for a maximum of five business days far review. Appointments <br /> accordingly. not be immediately available for review. Anew <br /> 3. A file that is actively being worked on by EHD staff may <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition'as released will The may require a�93.DO organized by d staff <br /> posit prior expense <br /> of the applicant Future file reviews by the same app ' Y <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> rocessed the next business day. <br /> G. Applications received after 3:00 pm will be p <br /> CONFIRMED APPOINTMENT DATE TIME <br /> I DATE NFIRED <br /> PHONE FAX INITIALS <br /> COM <br /> REVIEWED YES NO REVIEW DATE <br /> EH6 A6-02-0e6 , <br /> d!{f200� <br />