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—Jul -07-04 01 :06PP . 0: <br /> �_. --u-0 PAGE 01 <br /> CrfV wa •vao�„ <br /> DATE RECEAIED SAN JOAQUrN COUNTY <br /> ENv,RONWNTAL HEALTH DEPARTMENT <br /> 3041"Weber Ave 3rd F100T Stockt=,CA 95205 <br /> (209)468-3420 Fax:(209)464-0138 Web:www.co-spm joagwn-ca us/ehd <br /> PYJRLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: V� l�r rl u x + BUSINESSIAGENCY: <br /> ADDRESS: (ds 1 160 i;es 1:577-6 �- <br /> HONt=_:�S�i Zy 3�-Ka-�� —...�FacsfMlLE: 5 - 3^��'!S .- <br /> TENTATIVE'Ap"NT1MEW DATE: 2I 2'' I C- { -.--Time: 1 0 lyY` <br /> (PteafW allow 1A txtelnwas days from date of application ummftta►) <br /> In CHECK BOX TO EXPFDITE REQU�s93.00FFEA-RE ESTnn PRESSED IN 3 BUStNE-SS DAYS - f -II <br /> SIGNATURE OF APPLICANT DATE I/ ll�_ <br /> Deort r4hit Use Only <br /> UNIT <br /> FILE ADDRESS <br /> r <br /> flet Unit f <br /> f <br /> U Unit 2 <br /> Unit 3 <br /> c. Street .� <br /> unit a <br /> Ste« Z.. ;�� <br /> L7 E�Zo Unit 5 <br /> a <br /> EWRONMENTAL HEALTH DEPARTMENT FILES <br /> -7 oay 5 7'i0 <br /> U HOUSING ASATFIAENT r3 SOLID WASTE 1=ACILITY <br /> UNDERGROUND TANK(UST)CLt±ANUP SITE(LOP) TY C3 SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NOK4-QP) 0 V� NNFOOD FACILITY <br /> D DAIRY <br /> UNDERGROUND TANK(MONITDRIWREMOVAL) C3CHICKEN RANCH CJ PKG 1REATMENT PLANT <br /> �(HAZARDOUS WASTE GENERATOR ❑ MOTULIHOTEL C3 PUMPERTItuCK/YARD11C TOILETS ~ <br /> TIERFo PERMrTTED FACILITY ❑ POOLISPA 0 LAND USE APPUtCAT14N SITES <br /> 0 TATTOOIBODY PIERCING 0 OTHER"-EME SPECIFY} <br /> r-1 MEDICAL WASTE FAOLITY <br /> 1. List Up td ten addressds in the spBC*Mbovp- Select the ty"(S) Df files from the list Obove by Checking <br /> the appropriate box(es). At least one file type MUST be selected. F 4g(2091 4"-0138 or ma(t <br /> gjLdTPA Indicate eve• appointment for review will be confirmed <br /> 2. EHD will notify the applicant if any EHD flies exist. An alppo <br /> approximately five DUSInes{days but no later than tan 01))days after rwT eipt of application- The fi{es <br /> will be held for a maximum of five business days for review. Appotntments Should be scheduled <br /> accordingly. <br /> g, A file that Is actively being worked on by EHO staff may not,be immediately available for review. Anew <br /> application may bo subrnitted when the flit:is available. EH6 staff at the¢Xpenio <br /> A, Any file not returned In the same condition as released will be reor9 hnii�93 00 de staff prior to(pence <br /> of the applicant. Future file reviews by the same applicant may req <br /> fi. 'TENTATM appointment dates must be conFirmed with EHD staff. _ — <br /> S. Applications received after 3-DO pm will be processed tits next business day, To - <br /> TIME .GoJDegl./, r <br /> CONFIRMED APPpfNTMEWT DATE. r +n r <br /> PATE CONFIRMED PHONE FAX IN 51 <br /> F''f Ss4 Si✓� <br /> NO RMF-W DATE <br /> DATE <br /> YE$ �-- <br />