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JUN-IY-20003 19:19 C.7"OOR EARTH TECH 209 532 0773 P.02 AAM JVa 11UllI l.vV11 Y ENVIRONWNTAL HEALTff DEPARTMENT �1 304 E Weber Ave P Floor Stockton, CA. 95205 �vtv 2 d ?QM9) 468-5420 Fax. (209) 464-0138 Web: wwW.co,san joaquin.ca,us/ehd ZIWIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION APPLICANT: PArw�- 9C= _,2 7A L.,c 7_ BUSINESSIAGENCY: as m ba R_ ADDRESS: 0'2-I663 Bj2jR6j LAlU6 _ ■ PHONE: wsim11.E: TENTATIVE' APPOINTMENT DATE: )00G7_Time: (Please allow 10 business days from I. of application submittal) CHECK BOX TO EXPEDITE REQUEST -$93.00 FEE -REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT 2 i D E Wui� L& U 3 "LIST" A11F +,UST rj HSI' `,JHW L(51 Vs7 Nw ENVIRONMENTAL HEALTH DEPARTMENT FILES Department Use Only n 1� UNIT 11� VV 0 Unit 1 Unit 2 /Unit 3 Unit 4 ❑ Unit 5 � -St UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ID HOUSING ABATEMENT SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) M FOOD FACILITY r SOLID WASTE VEHICLE UNDERGROUND TANK (MONITOR1NGfREMOVAL) ❑ DOG KENNEL 9�f DAIRY HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY Cl MOTEUHOTEL 0 PUMPER TRUCK/YARDICHFM TOILETS Q TATTOO/BODY PIERCING M POOLISPA )LAND USE APPLICATION SITES $61` MEDICAL WASTE FACILITY Q OTHER (PLEASE SPECIFY) 1, List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464.0138 or mail to the address Indicated above. 2. EHU will notify the applicant if any EHA files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant, Future file reviews by the same applicant may require a $93.00 deposit prior to review 5. *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMFNT DATE TIME DATE CONFIRMED PHONE FAX' INITIALS REVIEWED YES NO REVIEW DATE tutst2001 TOTAL P.02 FILE ADDRESS F11-1 N 2. sweet 3 � G 3. suset I o a 4, StreetG s. street 1 V 5 Fi a Ve • 6. Sheet 2!j 61 o . -2ty G 7_ sweet S - I afy B. 3veel % 1 O '. ' a 9. Sltttel W . �o. sweet 5 o�ICf`On ENVIRONMENTAL HEALTH DEPARTMENT FILES Department Use Only n 1� UNIT 11� VV 0 Unit 1 Unit 2 /Unit 3 Unit 4 ❑ Unit 5 � -St UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ID HOUSING ABATEMENT SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) M FOOD FACILITY r SOLID WASTE VEHICLE UNDERGROUND TANK (MONITOR1NGfREMOVAL) ❑ DOG KENNEL 9�f DAIRY HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY Cl MOTEUHOTEL 0 PUMPER TRUCK/YARDICHFM TOILETS Q TATTOO/BODY PIERCING M POOLISPA )LAND USE APPLICATION SITES $61` MEDICAL WASTE FACILITY Q OTHER (PLEASE SPECIFY) 1, List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464.0138 or mail to the address Indicated above. 2. EHU will notify the applicant if any EHA files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant, Future file reviews by the same applicant may require a $93.00 deposit prior to review 5. *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMFNT DATE TIME DATE CONFIRMED PHONE FAX' INITIALS REVIEWED YES NO REVIEW DATE tutst2001 TOTAL P.02