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��If/06/04 MON 15:28 FAX 415 543 5480 TETRA TECH EM INC SF <br />ATE RECEIVED " <br />SAN JOAQUIN OUNTY <br />ENVIRONMENTAL HEAL'iH DEPA.RTmNT <br />r-,6 - J - 304 E Weber Ave 3`4 FloQr Stockton, CA 95205 <br />DEC 6 20R" 209) 469-3420 Fax: (209) 464-0138 Web: www.co.san joaquimm Wchd <br />.oji rI ;,j�C1.1�-i'LI' <br />L_ i v :: M <br />L <br />1IE- <br />pp��,Ll(i,��ITI�'f=4��,1i� <br />APC.l1N7 <br />E � <br />ADDRESS:2 <br />_. <br />PHONE-_ <br />PUBLICRECORDS RELEASE APPLICATION <br />!t "� V11S¢VESSIAtiENCY: �' ' �r <br />%P /100 <br />FACSIMILE: <br />N, <br />EHo LOG NUMBER <br />TENTATIVEa APPafttT>viNT DATE: Ttmo: pp opin <br />erif��r ED <br />(Pia allow 10 business days from date of application submIMA E[� U "l <br />Q CHECK BOX TO EXPEDITE REQUEST- <br />PUBLIC <br />EQUEST- <br />SIGNATURE OF'APPL.ICANT <br />H W � �5 Tj r!. Sheet <br />U� 9. serN <br />W <br />M4 <br />3 BUSINESS DAYS ; <br />DATE G 0 <br />Department Use Only <br />176V3 I <br />(< <br />GsY `yS <br />S / <br />CW <br />951 Yo <br />z v <br />—0 <br />a <br />(19 N 5J1 Loo 1 c <br />a- r 6 j (�C NViRONMENTAL HEALTH DEPARTMENT FILES <br />NVERGROUNO TANK (UST) CLEANUP SITU (LOP) ❑ HOUSING A9ATEMENT ❑ SOLID WASTE FA ALITY <br />❑ FOOD FACILITY o SOLID WASTE VEHICLEOTHER GLFANUP SITE (NON-i3OP) , <br />0")UNDERGROUND TANK (MONITMNGlREMOVAL) E3 DOG KENNEL U DAIRY <br />E" HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />Q TIEREb PERMrTT`ED FACILITY C3 MOTELIHOTEL ❑ PUMPER TRucjejy,ARD/CiiEM TOILETS r� <br />O 'rA71'0016()13Y PIERCING <br />p POCLMPA © LAND USE APPLtCATfaN SITES <br />EJ MEDICAL WASTE FACILITY O OTHER (PLEASE sl'lrciFY) <br />1. Ust up to ten addresser, In the space above. Seloct 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 th0 <br />address indicated above. <br />2. END Will notify the applicant If any END files exist_ An appointment for review will be confirmed <br />approximately five business days but no later than ten (10) days after receipt of applleation. 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 workdd on by EHD staff may not be immediately available for review. A new <br />application may be Subrnitted when the file Is available. <br />4. Any file not returned In the same condition as released will be reorganized by END staff at the expense <br />of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to review <br />5. *TENTATIVE appointment dates must be confirmed with EHO staff, <br />6. Applications received after 3;00 pm will be processed the next business day. <br />­0NF1R4t1D. i Pt`IIN MENT.I)A* E a 3r� TIME <br />iiATEGCJN>=IRM'p„';';,r;_ '` ;'RHONE . FAX:' ` Ih(1flAIsS.:`. <br />`M=MEWED YES NO REVIEW DATE, r;^ <br />