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ENVIRON MEN r HEALTf I P 13LIC RECORDS RELEASE APPLICATION <br /> <br />PER44-7 4Vi- .C.,,,-•• <br />APPLICANT: 3)4-AY1M. --S 1 c*J.5 4 BUSINESS(AGENCY: N 'e 1 1 6 <br />ADDREss: ci- 0.)-- Lisi"\-• ri 7.,‘) (Alsk\--) 1.--,0 <br />PHONE: 3 63-370 3 FACSIMILE: 3 Vi — 14, <br />TENTATIVE* APPOINTMENT DATE: Juil 16-5) 0 G Time: <br />eportnmnt Use Only <br />UNIT <br />E Unit 1 <br />tir).4 2 <br />Ui;A 3 <br />/ Unit 4 <br />E UNA <br />DATE RECEIVED <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 E Webor Ave 3rd Floor Stockton, CA 95205 <br />JUN 2 3 2006(209) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/elul <br />1;HC LOG NUMBER <br /> <br /> <br />lease allow 10 lousine days from date of appliuotion submittal) <br />7 <br />/ <br />CHECK BOX TO EXPEDITE RE <br />SIGNATURE OF APPLICANT <br />uEsT P ,E_ssED IN 3 BUSINESS DAYS <br />DATE 7 46 <br />T $93,00 FEE <br />_ FILE ADDRESS . • , <br />1.s:rf,_p_L_ jj 0 I \,--I U\1n53 64 my s--r„ ,.. LI tin <br /> <br /> <br />S:rml 1, City <br />S:rElel City _ <br /> S!rett Rt.AA5_1 cay <br />5:.. SIrmt r\ .0 e\ 5 .5 City <br />E. S'ant Clly <br />7. 5;flet .1—(..) Ctty I <br />;,. Vraet U N .. _) ctly <br />EL Slreet CI <br />IC, S:r1,ec .*: <br />EPARTI,'*, ENV1RO <br />TANK (UST) CLEANUP SITE (L <br />Az OTHER CLEANUP SITE (NON-LOP) <br />UNDERGWUND TANK (MONITORINGIREMOVAL) <br />HAZARDOUS WASTE GENERATOR <br />le; TIERED FERIVITTED FACILITY <br />TATT00Ia00Y PIERCING <br />MEDICAL WASTE FACILITY <br />HOUSING ABATEMENT <br />FOOD FACILITY <br />DOG KENNEL <br />CHICKEN RANCH <br />MOTEL/HOTEL <br />POOL/SPA <br />OTHER (PLEASE SPECIFY) <br />SOLID WASTE FACILITY <br />SOLID WASTE VEHICLE <br />DAY <br />PKG TREATMENT PLANT <br />PUMPER TRUCK/YARDICHEM TOILETS <br />LAND USE APPLICATION SITES <br />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. <br />EHD will notify the applicant if any EH D files exist. An appointmenf: for review will be confirmed <br />approximately five business days but no later than ten (10) days after receipt of application. The <br />will be held for a maximum of five business days for review. Appointments should be scheduled <br />eccordingly. <br />A file that is actively being worked on by El-ID staff may not be immediately available for review. A new <br />application may be. submitted when the file is available. <br />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 rind <br />'TENTATIVE appointment dates must be confirmed with EFID staff. <br />Applications received after 3:00 pm will be processed the next business day. <br />CONFiRMI:i0 APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />LIAO 44342-0D6 <br />Ch112003