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09/29/2004 09:21 2094671 AGE STOCK ON - PAGE k)/0 <br /> 7I EHD LOG NUMBER <br /> DATE RECEIVED, - SAN JOAQUIN COUNTY <br /> SEP 2 20011 ENVIRONMYNTAL HEALTH DEPARTMENT <br /> NV�RufVPd!E;, 304 E Weber Ave 3`1 Floor <br /> FE Stockton, CA 95205 <br /> ���� <br /> IE,S TH(209)468-3420 Fax: (209)464-0138 Web: www.co.san joaquin.ca us/ehd <br /> r;Ilr': FR'✓ICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Yllf'" Se BUSINESS/AGENCY: 11 6V <br /> ADDRESS: 33 7 4Skg-\ (� U <br /> PHONE:C" �L /— 10`6 FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: —Time:_ <br /> (Pieese allow 70 business days from data of appllcatlon submittal) <br /> 13 CHECK BOX TO EXPEDITE REQUEST•$93.00 FEE-REQUE PROCESSED IN 3NSINESSOAYS A <br /> SIGNATURE OF APPLICANT ��DATE / ^ —d/ <br /> Dapanment Use Only <br /> _ FILE ADDRESS UNIT <br /> I. 3-M JI061 W4+0(G94 ❑ Unit 1 <br /> 2. S CIN <br /> 3, SnM CRY Unit 2 <br /> a srer a <br /> )0J-1�L <br /> e. slror. 1��✓ <br /> z s., Unit 4 <br /> e. so-eet a <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> .:A UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELRIOTEL 17 PUMPER TRUCKIYARDICHEM TOILETS <br /> 173 TATTOO/BODY PIERCING ❑ POOLISPALAND y E PLICAT�ON SITESr <br /> ❑ MEDICAL WASTE FACILITY )IT OTHER(PLEASE SPECIFY)MGIIn'4i L� L17 L^+UrtC-y CC.t� <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)464-0138 or mall 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 /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMEN.T2DATE TIME <br /> DATE Ct7NFIRMEb PHONE FAX. INl"nALS <br /> REVIEWED YES NO: REVIEW OATS' <br /> eno NO2-0Ga <br /> r,ermos �,�aq_o(,T; � r�ct�sl-or �J sGL� ©ply w 0s o.? <br /> a,,ec n tt� /��`j le i K� <br />