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/22/2004 11:59 3037638889 TECHLAW INC <br /> - PAGE 03/0 <br /> W, �..�' EHD LOG NUMBER <br /> TIS *MEW, <br /> L� SAN JOAQUIN COUNTY <br /> F LJ ENVIRONMENTAL]REALTH DEPARTMENT <br /> JUN 2 2 2Q96304E Weber Ave P Floor Stockton,CA 95205 <br /> t 9)468-3420 Fax: Q09)454-0138 Web:www.co.san-joaquin.cams/chd <br /> T <br /> ENViRUNMENHEALTH NM NT EF�� PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT. _ 1111�P1 BUSINESSIAGENCY: —T�/A '0 VU - <br /> ADDRESS: C�Ino (�0 G ✓1ell-icy no 6 0 1 cii V1 RO Y 0 1 <br /> PHONE: IU3� I Lo `?-21FACSIMILE: ?2 021 <br /> TENTATIVE"APPOINTMENT DATE:_ 1 i ,� Time: <br /> (Please allow 10 business days from date of appilcaUan submhtal) <br /> El CHECK BOX TO F-RaEDITE REQUEST-$jN 93_ E.00 FE —REQUEST PROCESSED IN 3130SINM DAYS <br /> SIGNATURE OF APOLICANT I./f' L "-Ina. 13ATE Z2 <br /> Deoartment Use Only <br /> FILE ADDRESS UNIT <br /> 1, stmtcn p Unit 1 <br /> 2. S"M S ' <br /> 3 street e- ' Vv G Unit 2 <br /> s. streetQ 1 2 Ox <br /> 10 / f <br /> Unit 3 <br /> 0. sveec �Clty <br /> 7, Street <br /> fi - <br /> & strait I • G <br /> B. street L Q A - MY A ❑ Unit 5 <br /> 70. 9lraoi t5 G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOF) O HOUSING ABATEMENT 501.10 WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 6 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH Q PKG TRFATMI^NT PLANT <br /> ❑ 71ERED PERMITTED FACILITY C3 MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> Cl TATTOOIBODY PIERCING ❑ POOtJSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up td ten addresses in the space above. Select the type(a)of files from the list above by checking <br /> the appropriate box(es). At least one fife type MUST be selected. Fax to(209)464-0738 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 later than ten(10)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 /> ecce ngly. <br /> 3. A file at 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 fill not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the ppllcant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 5. •TENTbTIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applic-Iations received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES HO REVIEW DATE <br /> eko.s.oz-QM <br /> erarlaos <br />