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11/26/2003 11:32 916-786-` LFR PAGE 02/E <br /> OAO JUAYU11-4 1—UU1-I1 Y <br /> ENVMONMNTAL HEALTH DFrAR 1rMNT <br /> 304 E Weber Ave 3Td Floor Stockton, CA 95205 <br /> NOV 2 (2209 00 4683420 Fax., (209)464-0138 Web:www.co.san joaquimca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> fir' 1 <br /> APPLICANT:1 b '`�s T�4^ ' BLIS.INESVAC ENCY: - - — - <br /> ADDRESS$• �j /�j� �OC/G4�S L'Gv17 �� iTG w GrQ �r �7� �' Gam' S / 5 <br /> HONE: '?/6- - 7e6 - 7_-469 _FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Flaase allow 10 buclness days ffi m date of appliCaUon submittal) <br /> C� <br /> Q CHECK BOX TO EXPEDITE REQUEST�$93.60 PEE-RE EZOC IN 3 13USINESS DAYS <br /> IGNATE OF APPLICANT - _- DATE <br /> UR - <br /> Depann%ent Use Or <br /> FILE ADDRESS UNIT <br /> Q 'Tac.,•�rvN a- S j] Unit i <br /> 2. sv,.t L-V6- X707 G KYz <br /> s. str.0 a ❑ Unit 2 <br /> {, a <br /> s. such U " <br /> a a <br /> I(F <br /> 7. $,roal c, Unit 4 <br /> aty <br /> y. G nit 5 <br /> o. srea <br /> cry <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(U91)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 19L OTHER CLEANUP SITE(HON-LOP) ❑ FOOD FACILITY p SOLID WASTE VEHICLE <br /> 1aC UNDERGROUND TANK(MONRORMGtREMLWAQ ❑ DOG KENNEL Cl DAIRY <br /> D NAZARnOUS WASTE GENERATOR O CH1CK1_N RANCH O PKG TREATMENT PLANT ' <br /> C=3 <br /> I TIERED PERMITTED FACILITY 0 MOT7A MOTEL Cl PUMPER TRUCKWARDICHEM TOW <br /> D TATrooIGODY PIERCING D POOLISPA ❑ LAND USE APPLICATION sans <br /> 4 MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> I. List up to ten addresses in the space above. Select the type(s) of files from the list above by checl g <br /> the appropriate box(es), At least one file type MUST be selected. 'Fax_to.(209)46"138 or mail to-t <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 fi <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 EHO Staff may not be immediately available for review. A N <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 expo e <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to reg v. <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 /> CONFIRMED APPOINTMENT VATS TIME <br /> DATE CONFIRMED PHONE .' FAX• INrrIALS <br /> REVIEWED YES NO REVIEW DA'Z'E <br /> EMIR 4E-0?.006 <br /> Eudlta0� . <br />