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11/26/2003 11:32 916-786-0366 LFR - PAGE 02/E <br />O'PAJ 1 .1 UAy UjuN .1—U U jN <br />I�. ( / ENVIRONMENTAL HEALTH DEPART'ME�` T <br />I�� I� (( ;! I'�I:-- �� )� 304 E Weber Ave 3r1 Floor Stockton, CA 95205 <br />(209) 468»3420 Fax: (209) 464.0138 Web: Www.co.san-joaqui.�a.mus/ehd <br />N 0 V 2 6 200315SI <br />=n��� c:;, „r.•, PU13LIC RECORDS RELE.ASIE APPLICATION <br />.dJfi�t-,J/Q <br />rrl., I <br />/tPPUl;.ANT: -_ �� �a�� [3tJSU1E3S/AGENCY: <br />ADDRESS: '� / j7 o v G 4 e v� s� m a� c5'.g :c Y'.� GA 15 i <br />ONE: �316- — 0 3 65 <br />TENTATIVE' APPOINTMENT DATE: _ Ttme: <br />(Phase a(IOW 10 bucrness days ft M date of vpplkCat3bn subtnittan <br />CHECK BOX TO FXPF-BrrE REQUEST. $93.00 FEE— RE / kQC tN 3 EUSINESS DAYS <br />SIGNATURE OF APPLICANT - DATE ii zs c�3 <br />FILE ADDRESS <br />9. S&Wp <br />4. <br />aty <br />s. <br />s <br />a <br />7. Sheet <br />City <br />o, shy <br />aty <br />9- <br />G <br />,o. sreet <br />Cny <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />Oepartment use Or <br />urlrT <br />`S C7 Unit i <br />D Unit 2 <br />Unit 4 <br />S <br />UNDERGROUND TANK (UST) CLEMUP SITE (LOP) ❑ HOUSING ABATEMENT M SOLID WASTE FACILrrY <br />-ML OTHER CLEANUP Sr'r'E (MON-LOP) ❑ FOOD FACILITY V SOLID WASTE VEHICLE <br />UNDERGIWUND YANK (MOMTORINGIREMOVAL) ❑ DOG KENNEL C1 DAIRY <br />STE HAZARaotlS WAGPNERATOR 0 CHICKFIN RANCH C PKG 'fREATA 12M PLANT , <br />i13TIEREDM <br />PERMITO FACILITY 0 MOT"OTEL. M PUMPER TRUCKWARD/CHEM TOILI <br />D TATTOO/BODYPIERCING D POOUSPA ❑ LAND USE APPLICATION VMS <br />C MEDICAL WASTE FACiLtTY 13 OTHER (PLEASE SPECIFY) <br />1. List up to ten addresses in the space above. Select the type(s) of files from the list above by cheel <br />the appropriate box(es). At least one file type MUST be selected. FaFto (209) 464 -0138 -or mail to t <br />address indicated above. <br />2. EHD will notify the applicant if any END files exist. Art appointment for review will be confirmed <br />approximately five business days but no later than ten (10) days after recelpt of application. The fi <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 on by EHO Staff may not be immediately available for review. A <br />application may be submitted when the file is available. <br />4. Any file not returned in the sarrle condition as released will be reorganized by EHO staff at the expo <br />of the applicant. Future file reviews by the carne applicant may require a $93.00 deposit prior to reg <br />5. 'TENTATIVE appointment dates must be Confirmed with 1= -HD staff. <br />6. Applications received after 3.00 pm will be processed the next lousiness day. • . <br />CONFIRMED APPOINTMENT 17AT>= TIMI~ <br />DATE CONFIRMED PHONE .' FAX • INMALS <br />REVIEWED YES NO REVIEW DATE <br />Fl�D 4a-Vi.Q06 <br />s/6itd0i <br />N <br />N_ <br />