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11/10/2003 16:30 46401 ENVIRONMENTAL HE <br /> DAJ;e�RF�CEIVE9, PAGE 02 <br /> JAj! j �� ' jl SAN JO,AQUIN COUNTY EHO Lot;NUMBER <br /> Ei NVIRONNIENTAL HEALTH DEPARTIIIElVx <br /> N 0 V j 0 Z 304 E Weber Avc 3nf F1OOr Stockton,CA,95205 <br /> 9)468-3420 Fax: (209) 464-0138 Web: www,cO.SaA-joaquimraus/ehd <br /> NO <br /> RPAITI�EQvIC,EQ. PUBLIC RECORDS RELEASE APPLICATION I <br /> J _ <br /> APPLICANT:_ l UJT'0ACo 1 1 Vl� 6USINE$S/AGENCY: �� I Cons I/( f--� <br /> • ADDRE99b0 Caa.ti i Dnp Iw{�lOr 5?c 2oCJ ll.)a•Qs•.�l•-C.rtr.,,�y C S Vhf�. <br /> HONE:.•=(2S Z�Qi3 6O0o ?� f0$- FACSIMILE: 125 2-eb3 6 2_/ <br /> TENTATIVE'APPOINTMENT DATE: I I j 17((T3 Time: 101,00 <br /> !� L <br /> (Please allow 10 buglnam days from date of application submittal) <br /> Q CHECK BOX TO EXPEDITE REQUEST-$9 .Oq ZEE EQUEST PROCESSED IN a uUSINESS DAYS <br /> .SIGNATURE OF APPLICANT - DATE _L1 110./03V 0 <br /> Depanment Usb OnIY <br /> FILE ADDRESS UNIT <br /> strzn 7-qq O r IV G vF L <br /> z secs 7$ Ge1uSd- fZe/ V r k ❑ Unit T <br /> a. strnn 23�5 �Iv yYac 1 Cl-ti�� <br /> +. ! w� rc (, RJ G ✓aa ❑ Unit2 lI <br /> s. <br /> simpt (NrsF 6Te'� 5fra.� R� <br /> �tlnit4 <br /> a. skm ram MJl r� S tu(�O+n Si !rac, 6"'S �r <br /> 8, 31Tet G <br /> ❑ <br /> Unit 5 <br /> 10, Sues G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOF) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> is OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORWOMMOVAL) ❑ DOC'KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH M PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELlHOTPL ❑ PUMPER TRUCK/YARD/CHEM TO <br /> C3TATTOOIBODY PIERCING ❑ POOLISPA M LAND USE APPLICATION SrrEB <br /> ❑ MEDICAL WASTE FACILITY ❑ 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(2091464-013a or mail to the <br /> address Indigated above. <br /> Z, EHD will notify the applicant if any F.HO 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 filas <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 reorgantzed by EHD staff at the expense <br /> Of the appllcard, 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 /> 61 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 /> .a moa <br /> rrarmaa I 'I4-o !Il J ��i-cr s u�dill�S (0' la s t ac�c�s �/{ F r n f P,r-'�r�%•1 t�f (v� d-C2,v'�'Y�1X-), <br /> PZr. iaw�rac . l(o(11 s . <br /> TO 3�dd 11 l (iae ([if si duns ol-�I3d/,�66,tLod <br /> TLT9E8LSL6 bE:LT E00L/0T/1T <br />