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MAY. 18. 1004— 2:08PM "--'NTGOMERY WATSON N0, 923EHOI.P, DUMBER , <br /> DATE RECEIVED �./ SAN JOAQM COUNTY <br /> D <br /> V�RONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> M AY 18 2R69)468-•3420 Fax: (209)464-0138 Web: www.co.san joaquin.ca.uslohd <br /> t-i`Jl.'IR JNNIENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PiLPIr.,: T . <br /> �/ � BUSINESSIAGENCY: <br /> APPLICANT: �vv <br /> 311 <br /> ADDRESS; <br /> PHONE;���1 �Z-�J �g FACSIMILE: M <br /> i <br /> TENTATIVE''APPOINTMENT DATE: Time: I <br /> I <br /> (Please allow,10 business days from date of application submittal) I <br /> CHECK BOX TO EXPEDITE REQUEST-$93 00 FEE–REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT4 — <br /> DATE ' <br /> t4oartmUse Only <br /> FILE ADDRESS UNIT <br /> Y00 �r,.r�✓� __2V_ o�� o✓1 a Unit 1 <br /> z s 5 G <br /> a s 00 & Unit 2 (�l1 <br /> �. C <br /> s. s d <br /> 6. street i~ O✓1 6 Gf <br /> Unit <br /> T. sit 1-7 0 o D <br /> s. sorest Unit 5 <br /> 9. s t <br /> o. Street <br /> Ot 9 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �, ❑ HOUSING ABATEMENT r3SOUD WASTE FACILITY <br /> X( UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOUD WASTE VEHICLE <br /> CI OTHER CLEANUP SITE(NON-LOP) 0 DOG KENNEL E31 DAIRY <br /> IIX UNDERGROUND TANK(MONITORINGIREMOVAL) (7 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ MOTEUHOTEL E3 pUMPERTRUCKIYARD/CHEM TOILETS <br /> Cl TIERED PERMITTED FACILITY p POOLISPA ❑ LAND USE APPLICATION SITES <br /> CI TATTOOIBODY PIERCING ❑ OTHER(PLEASE SPECIfrlt7 <br /> ❑ MEDICAL WASTE FACILITY <br /> List up to ten addresses in the s <br /> •{, pat®above. select the typ®($)of files from the list above by checking <br /> the appropriate dresses. At least one file type MUST be selected. Fax to(209 464-0'138 or mail to the <br /> address indicated above, ointment for review will be confirmed <br /> 2. EHD will notify the applicant if any EHD files exist, An app s after receipt t of application• The files <br /> approximately five business days but no later than ten(10)day ointments should be scheduled <br /> will be held for a maximum of five business days for review. App <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. v <br /> ne <br /> application may be submitted when the file is available. reorganized b EHD staff at the expense <br /> 4. Any file not returned in the same condition as released ant may require be a $93.00 deposit prior to review <br /> of the applicant. Future file revi®ws by the same app <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 3:00 pm will be processed the next business day. <br /> 6. Applications received after ` <br /> l�IR �Pt�Itmo-I-f 1?IIbrT ''», ` .�t r �u . I r. ;ti �, : L t• r,'r. �'� <br /> Y i,6^"�'rr¢, -rr• •+Y !~ fi1/ti�..y, • . �y yiL c w <br /> •r ',• Lal' •y° �� !f.�{�' ,' •.I. !' ,ii 1Ey �` ?• '' •{• ;�,,.i uY �p�e1x1�L•v��!'�,('_.�u.—' <br /> DAA G*ONl~tRNl1p ;.�� �' :a ,r <br /> RVJ"rte i^ A^ <br /> REVIEWID YE$ <br /> N �. <br /> r;HO 43.0244 <br /> 9192003 <br />