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06/03/2004 10:24 2094671116 AGE STOCKTON - PAGE 01/0 <br /> iis EHD LOG NUMB <br /> GATE RE(�CEIVED SAN JOAQUIN COUNTY <br /> EN04 E Weber <br /> 3 HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> JUN 0 3 26N9)468-3420 Fax: (209) 464-0138 Web: www.ro.san-joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> E _ <br /> BUSINn�E/SS'I}A�GENCY: �d ne &a rbn of <br /> ADDRESS: 3 <br /> PHONE:- a0- ZV-100la FACSIMILE: <br /> O <br /> TENTATIVE'APPOINTMENT DATE: :nes Jun Q <br /> (Please ail w 10 business days from date of apPllcatlon submMan <br /> l� anyare ready•• . . <br /> x CHECK BOX TO EXPEDITE REQUES -S9 .00 FEE-REQUEST ROC SFO IN 3 BUSINESS DAYS' '7/M <br /> /SIGNATURE OF APPLICANT DATE y <br /> artment Use ONY <br /> c� C� <br /> FILE ADURESS UNIT <br /> iDli1 sr N t S o ❑ Una 1 !Jy <br /> Yzm <br /> s"at t uy Unit 2 �y�' <br /> V..t R u �d// ) <br /> Unit 3 V <br /> s swot CI 5 r✓ <br /> S� ,E. _ nUy C ° Una <br /> 0 Unit5 <br /> ta, swet RU - �ChA 7I12C L <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ?t7' <br /> fNDERGROUNDTANK(US'r)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE ACILI'fTHER CLEANUPSITE(NON-LO ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLENDERGROUNDTANK(MONITOING[REMOVAL) ❑ DOG KENNEL DAIRY <br /> AZARDOUSWAsrEGENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TEREO PERMITTED FACILITY O MOTELlHOTEL Q PUMPER TRUCKlYARDICHEM TOILETS <br /> ❑ TATTOOMODY PIERCING ❑ POOLISPA .LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLrASE 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)46A 0138 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 /> G. Applications received after 3:00 pm will be processed the next business da <br /> a: <br /> v.> <br /> .r <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ' �-0°' �/3/ .Gl/I vip> Hurd e,p `- za�n e I YgarIP7 <br />