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06/25/2004 13:52 20946770 AGE STOCKTON I PAGE 01/0 <br /> DATE RECEIVED, EHD LOG NUMBER <br /> Inp =�:iS�:���/i _���=�� SAN JOAQUIN COUNTY <br /> CLj _, I \/ �. ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUN 2 5 20 304 E Weber Ave 3d Floor Stockton, CA 95205 <br /> (709) 468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH r PUBLIC RECORDS RELEASE APPLICATION <br /> r.r r F i, <br /> APPLICANT: BUSINESSIAGCNCY; f <br /> ADDRESS: OQ A �7 <br /> PHONE: O7n FACSIMILE: �07- <br /> TENTATIVE*APPOINTMENT DATE: i&LU, 30'10de Qy. Tim,: & op <br /> ,14 Ohl`„ <br /> f L:✓1 (Please allow 10 buslnass days from data of application submthaD <br /> (% y J� <br /> int (011'7( oad <br /> CHECK BOX TO EXPEDITE REQUE - 93.00 FEE—RE UEST PROCESSEDQIN�3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT dJJZ..K07 C �L DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> s.a QC uIr 401. e <br /> _ spa G N o ❑ Unit 1 <br /> s. sxet w- .R <br /> D �Unt2 (P Z <br /> a. Street <br /> c A � <br /> eV Unit 3 <br /> e. saen _ <br /> 7, Street ON V <br /> Unit 4 <br /> e saeec c <br /> e. Sweet G <br /> nI 5 <br /> 10 Street G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILESt ay <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILIT1i� F F',_--�.,1 <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE- _,:;r <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIRY `- <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOMODY PIERCING ❑ POOLISPA >.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)464-0136 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 /> 6. Applications received after 3:00 pm will be processed the next business day, <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED4 ,1 +a•- <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EI+a ae.o:.aaa <br /> alnZaa9 <br />