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NOV. 16. 2004 11 :20AM COR EARTH TECH __ NO. 7885 P. 1 <br /> DATE RECENEQ END LOG NUMBER <br /> SAN JQAQ�'IN COiJNT"'!t (7 t' <br /> ENVMONMENTAL HEALT)a DEPARTMENT <br /> 304 E Weber Ave 31d Floor Stockton,CA 95205 <br /> 2Q9 468-3420 Pax: (209 �1b4-0138 Web:www.co.sanjoaquin,ca-uslehd4000 ?0000 <br /> PYJBLXC RECORDS RELEASE APPLICATION 1 <br /> APPLICANT: �"s +� 13USINESSIAGENCY: 1r�atC��' � tu <br /> ADDRESS: IB.5Fvp_v,L ►tJ sf Circle., Ste- T. Si-o <br /> PHONE: 2,(221-2-34-0m FACSIMILE: 2-0 1 2.34-0 <br /> TENTATIVE}APPOINTMENT DATE: 12'212[70 Time: '��?� <br /> (PIme allow 10 business days from date If application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93-00 FEE-RE7"u,/-- DATE <br /> ST PROCESSED INS BUSINESS DAYS <br /> SIG14ATURE OF APPLICANT � q <br /> Pam"(Use Only <br /> F1 L1=ADDRESS UNIT <br /> street 9-17 ee_ a i o,n _ ❑ Unit 1 <br /> Z, street 1144 S. V'n c- a / <br /> a. .SUW gni 44Aa �� _ Unit 2 <br /> e. Srwt 3 �!f t rerz I' ai <br /> s. Stray 12.1 �a.ro� ie -� '`' Unit 3 <br /> 6. Street <br /> 1-10 at ,L. <br /> r. stt�e+ v5 1�- •�C ( 5:f� - G y/� /Z 1 Unit 4 <br /> e. syeal 1�;�:2 S O ctL-c.t-;cS-t- <br /> a 5lrsel I 4-DeL� a p' � El Unit 5 <br /> suE " Q ` Cay -A <br /> lar <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FILES <br /> XUNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING A.HATEM, NT SOLID WASTE FACILFTY <br /> $.OTHER CLEANUP SITE(NON-LOP) D FOOD FACILITY d SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONTTORINWREMOYAL) 0 DOG KENNEL O;DA[Ry <br /> 3'HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH Q PKG TREATMENT PLANT <br /> TIERED PERMFTI`ED FACILITY E7 MOTELIHOTEL 13 PUMPER TRUCKMARDICHEN TOILETS <br /> TATTOOIBOOYPIERCING 0 P001JSPA WLANDUSE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY LT OTHER(PLEASE S EC1FY) ��.. <br /> 1. list up to ten addresses in the space above. Select the type(s)of Tiles from the list above by checking J <br /> the appropriate box(es). At least one file type MUST be selected. Fax to-(209)464-0138 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 EHE}staff, <br /> 6. Applications received after 3:00 pm will be processed the next business day. . <br /> )",A' 0 <br /> li <br /> 1 <br /> 1I' <br /> �+tnae.ux.00e <br /> erenaos ' <br />