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__-l14/18/2005 10:15 FAX 209 94801 002/002 <br /> °Ino-��I�� SAN,TOAQiJ1iY COUNTY <br /> y ��� ENVIRONMENTAL HEALTH DEPARTMENT <br /> P p R I u 9005 304 E Weber Ave 3"Floor Stockton, CA 95205 •oo= <br /> (209) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaqwa.ca-us/ehd <br /> ENV4r",ONMENT HF_AL?H <br /> PEHMi1/SE9V!CES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Ry'"" 1544-S1,hL <br /> a,L BUUSINESS/AGENCY: /JI2.111Qua <br /> ADDRESS: <br /> � � -�.6f___C_I�Y1r'+IQ. tll'fYP� SI` ')bt CVl bJS Imo)` <br /> PHONE:Iaq) �f�-�S^ 13y FACSIMILE: 1AR) q4R— --421 ' <br /> TENTATIVE'APPOINTMENT DATE: /Ja9 �5 Time: /aJa <br /> (Please allow 10 business days from date of appdm9on submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-;93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ % --s#� ��1 DATE <br /> Oe"(U"ent Use O,dy <br /> FILE ADDRESS UNIT <br /> saa 1,40& W. c47RA MOAD an Lc01 ,eACq ❑ Unit G <br /> z. saensn 1Af• toTTA MAD, QN 1--01 ,y <br /> 'Foeo W. &o A V-MAD 02 400/ ZZC <br /> HZUnit2 1 p„ Ae) <br /> 4 sad fJtlB <br /> s. w+ ' 9 A 17_° a !� 29 ' a �Yl1 Unit3 <br /> at, I -y Unit <br /> 9 sued nit 5 <br /> 19. std <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) U HOUSING ABATEMENT ad.SOLID WASTE FACILrry <br /> OTHER CLEANUP SITE(NON-LOP) t3 FOOD FACILITY 0 SOLTO WASTE VEHICLE <br /> Ila UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL EL DAIRY <br /> X1 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0-PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPERTRUCKrYARDICHEM TOILETS <br /> ❑ TATTD0/500Y PIERCING ❑ POOLISPA Is. LAND USE APPLICATION SITES <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 209 464-138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD Tiles 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 neN <br /> application may he submitted when the file is available. <br /> 4. Any file not retumed in the same condition as released will be reorganized by EHD staff at the expens <br /> of the applicant Future file reviews by the same applicant may require a $91.00 deposit prior to reviel <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 /> TIME i. "1.4.iYY �nR1. :.I•"'.✓�''. <br /> • ,. <br /> �,CONFI,RMED,APPOINTMENT:D'ATE ar ' - .�"�+_+.�:. ' - •--+�� :":;a:' <br /> BATE CONFIRM EQ PHONE FAX' ;INfC1ALS <br /> REVIEWED YES NO REVIEW DATE. <br />