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06/16/04 WED 08:49 FAX 916 ^'6 7013 KLEINFELDER �00 <br /> DATE RECEIVED 'r./ SAN JOAQUIN COUNTY <br /> LR? lJ 1J L�LJ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> JUN 16 2004(209)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/ehd <br /> ENVIRGyiAENT N PUBLIC RECORDS RELEASE APPLnICATION <br /> P MiT/SERVICS t(�„ � P BUSINESSIAGENCY:_ P i(lt�er' l� <br /> APPLICANT:22 ePP 7i_ L_1 1_i _q 1 <br /> ADDRESS:,.c�C7 /"/ �1 l a�c C.ti rn ,ten ,n•tT, ��_ <br /> PHONE: 1 9�Ca�. o o— �O FACSIMILE:191(0� <br /> TENTATIVE'APPOINTMENT DATE:A� 1>n� r Pn r I S� nnVt'Xl( 1me: <br /> (Please allow 10 business days from date of application submittal) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$93.00 FE REQUEST PROCESSED iN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANTIV Department use <br /> OnlY <br /> FILE ADDRESS <br /> a 77 t o ne ✓ a — ElUnit 1 <br /> ,. sd 1 f, <br /> 2. Shed 9 e' , a ❑ t <br /> 2 CA <br /> Unit 2 q ll <br /> 4. Swed I <br /> s. sued ATn Unit 3 <br /> 6 saed <br /> a V1 Unit 4 <br /> �. Sftd tt�C <br /> �� �'`� Unit 5 <br /> s. ss 55a <br /> ,o. sre Wl8'7 e- a <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 93 UNDERGROUND TANK(UST)CLEANUP SiTE(LOP) HOUSING ABATEMENT 13 SOLID WASTE FACILITY <br /> ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ® OTHER CLEANUP SITE(NON LOP) E3 DOG KENNEL ® DAIRY <br /> 19 UNDERGROUND TANK(MONJTORINGIREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 63 HAZARDOUS WASTE GENERATOR ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY p POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <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 mail to the <br /> address indicated above. y appointment for review will be confirmed <br /> 2. EHD will notify thea applicant if an EHD files exist. An <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 avallabie for review. Anew. <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$93.00 deposit prior to review. <br /> 5, 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:60 pm will be processed the next business day. <br /> TIME <br /> CONFIRMED APPOINTMENT DATE <br /> DATE CONFIRMED <br /> PHONE : FAX' INITIAL$ <br /> REVIEWED <br /> YES NO REVIEW DATE <br /> =• - <br /> END 6-M-006 <br /> r)f6f2003 <br />