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12/11/2003 08:25 9168610432 SECOR PAGE 01/e <br /> v 12105/2003 12:51 4640138 EWIRONMENTAL HEAD PACS 01 <br /> P00,111*Fax Npte 7671( SAN J OA U zN COUNTY <br /> EN,'IRONMENTAL HEALTij,DEPARTMENT <br /> OCC J. 1 2003 304 E Weber Ave 3M,Floor Stockton,CA,95205 <br /> - .49)468-3420 Fax: (209)464-0138 Web! www.CO.san-joaqUin,ca.us/r' <br /> 1 i-�_;k L h i I do <br /> Pt f-1 " ' _r ' ,E�; PUBLIC RECORDS RELEASE APPLICATIOr— <br /> APPtICANT% DklbL.Lkez BUSINHssIA¢ENCY: &CQ� ry1�LA '-7 <br /> ADDRESS: � � goad 5( L:k IOU hoop Ja-a �� '70 _ <br /> PHONE: 21 to R(n�-,�.�..Q.�.,._ • —FACSIMILE: ((P.-9 -dL13 <br /> TENTATIVE*APPOINTMENT DATI Dze_,t btit 301 Q003 Tj": 10=00 !4i"1 <br /> (Please allow 10 business days from date of appllca(lon&ubrnihal) p <br /> L-1 C148'CK BOX TO EXPEDITE RL UEST•393C <br /> ,oQ F -RECtUt?ST NRQCESSED IN 3 BUS1NB65 BAYS L ! � <br /> SIGNATURE OF APPLICAN DATE —1,11111'a`1 �„� <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. un+Utle &adov, TtAt,. Q Unit 1 <br /> z. s+ <br /> U—U UUI UUI LIMPL=EU EL=LW <br /> 1r <br /> �C <br /> Unit 3 <br /> ONUnft 4 <br /> 9. rear CRX 0 unit 5 <br /> 10. aim <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ UNDERGROUND TANK CUST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> O OTHER CLEANUP SITE(NON•I,OP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONiTORINGtREMOVAL) O 000 KENNEL ❑ DAiRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKO TREATMENT PLANT <br /> C3 TIERED PERMr=D FACILITY d MOTEUHQTEL O PUMPER TRUCWYARDICHEM 7811-2T9 <br /> C3 1"ATTOOiRODY PIERCING ❑ POO1.J3PA ❑ LAND U9R APPLICATIONIiW <br /> ❑ MEDICAL WASTE FACIL" (9-1OTHIER(PLEASE SPECK <br /> 1. List up to tett 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(20114-6-4--0138 or mail to the <br /> a dross i dlEatect above, <br /> �. EHD will notify the applicant if any EHD films exist. An appointment for review will ba confirmed <br /> approximately five business days but no later than ten(10) days after receipt of application. The files <br /> will be hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked an by EHD staff may not be Immediately available for review, Anew <br /> application may be submitted when the file is available. <br /> d• Any flla nut 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 /> 0. Applications received after 3:00 pm will be procrassad the next business day. <br /> CONFIRM I) APPOINTMENT DATE TiME <br /> DATE CONFIRMED PH® E FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Ma"•021006 <br /> �a Ac <br /> on dy nktd s= a.W, c)t porn-H.0O 'e-r�-Ph-e er r Ks <br /> lhct'3 4-0 i urr � <br />