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a <br /> G r pixy 4i ;•,yrsf+ t p'vrs <br /> 0iO4i2004' 10:01 twJ Lou: <br /> VW <br /> FAM NUMIt3tK <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> Ell <br /> r��' I�f �L� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 344 E Weber Ave Yd Floor Stockton,CA 95205 POW <br /> 0 C T Q 4 2004 QVv55 <br /> (209)468-3420.Fax:(209)464-0138 Web:www_co.san joagWn.ca.us/ebd <br /> ENVIFiGi'v i : u l f int;:i H PTJBLTC RECORDS RELEASE APPLICATION <br /> PFRPdIIT,` �l=RVIC F APPLICANT-'DEUSINESSIAGENCY: of <br /> ADDRESS: a��"' <br /> PHONE: J t-L I D _FACSIMILE: 2,1D <br /> TENTATIVE*APPOINTMENT DATE: Time: - <br /> (Please allow 10 business days fns date of application subrtiilW) <br /> ® CHECK BOX TO EXPEDITE RE EST-$93.00 FEE UtSST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT V DATE Z ® �— <br /> DsPwhTmA tlss Only <br /> UNIT <br /> FILE ADDRESS <br /> ems ' ❑ Unit 1 <br /> [3. <br /> StreetSuess 1 ❑ Unit 2 <br /> 4 SUW <br /> S s ® Unit 3 <br /> 6. S <br /> T. sheet ❑ Unit 4 <br /> '• e. sheet ❑ Unit 5 <br /> 9. Street <br /> 10. sheet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> F 4 <br /> E3 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT E3 SOLIDWASTE <br /> D FOOD FACILITY D SOLID WASTE <br /> D OTHER CLEANUP SITE(NON-LOP) [3 DM KENNEL ❑ DAIRY <br /> E3 UNDERGROUND TANK(MONITORINGIREMOVAL) O CHICKEN RANCH ClPKG TREATMENT PLANT <br /> ❑ HAZARDOUS WASTE GENERATOR cl MOTELIHOTEL CI PUMPER TRUCIVYARDICHEM TOILETS <br /> D TIERED PERMITTED FACIL[TY .❑ POOt.ISPA ❑ LAND USE APPLICATION SITES <br /> D TATTOOIBODY PIERCING • 13 OTHER(PLEASE SPECIFY) <br /> O MEDICAL WASTE FACILITY <br /> q, List up to ten addresses in the space above. Select the type(s)of files from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(20914ti4-0136 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 tater than ten(I o)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 fele 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 /> 1 g. Applications received after 3:00 pm Will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED MALS <br /> PHONE FAX'' (N <br /> i REVIEWED :.. YES <br /> REVIEW DATE.• . <br /> °�,�*4 vy7 Fie, FOV Zir ^� go1 rt WOW Vf <br />