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�_ ►?� -03' 03 (FRI) 15:35 CITY 00 OF S. F. PARKING DEPT TELA q 554 9834 P. 001 <br /> 1 U/0j1'L00.i 0y: 21 469401 Ju ENV1I•'UNMEN I AL HE PAGE 01 <br /> OATS ElVEp City tuu r�uiwac <br /> �1 SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEAL rH bEFA,RTMENT <br /> OCT - 3 2003 304 E Weber Avv 3'4 Floor Stockton, CA 95105 <br /> (209) 468-3420 Fax: (109) 464-0138 Web: www,co.san joaquin.cn-us/ehd <br /> "NVIRCINNIE( 1 HEALTH <br /> PFRMIT'SERVICES pU-BLIC RECORDS RELEASE APPLICATION <br /> AAVOCANT; �rBUSINEBBIAGENCY: <br /> A13URESS: V A �em440 <br /> PHONE; �L FACSIMILE: if 6T 65 — C� ! <br /> TENTATIVE*APPOINTMENT DATE: Qom-' Z3225— TIME, <br /> (Please allow I Gu91nes�-days tram date of oppllcatlon rwdml <br /> CHECK BOX TO EXPFPITI=REQUEST-;9a EE-RE G Ep IN a BUSINESS 4YArT <br /> SIGNATURE OF ,4PPLlCA <br /> DATE <br /> eAaftmer}I Use©t1lY <br /> FILE ADDRESS UNIT <br /> rj Q Unit 1 <br /> Ire <br /> r <br /> A# StrPni c, Unit 2UUUU LME <br /> �Ir I C <br /> b r <br /> Unit 3 <br /> s S <br /> G llrllt 4 <br /> U3 <br /> y <br /> SVC 1 „� 1 <br /> r � <br /> city <br /> arae <br /> ENVIRONMENTAL_ HEALTH DEPARTMENT I'(l-ES <br /> UN"RG€t,QuND TANK(UST)CLEANUP SITE (LOP) O t1CUeING ABATEMENT -< WA97. <br /> QTttER CLEANUP 5(TF(N17N,t IJt') tl FOOD FAGIL�ITY OLID WAgn- <br /> t,Hpt=RGRaU1�lD TANK(f�1QNITORINGrRL:fdOV ) Q DOG K5NNF1. a DAIRY <br /> HAZARDOUS WASTE GFNFRATQR © CHICKEN RANCH Ca PUM TREATMENT PLANT <br /> ARDIC <br /> � TP!'_RER Rt:RMiTTEo FACILITY ¢ MC3TI;UH4TEL Q piJf�PER TROCtuYAFi01CHEM TOILETt3 <br /> C1 TATTOQIROCY PIERCING a Po0I.JSPA ❑ LAKE U98 APPLICATION 51TES <br /> rM ME131CAL WASTE FACILITY ❑ OTHFi7 IPI EASE SPECIFY) <br /> 1. List up to ten addras$as In tho space ahsave. $aIoct the type(s) pf files from the list abay a by 0ackin9 <br /> the appropriate box(ep), At least one file type MUST > e selected. En or ail to thd <br /> a es a Dove, <br /> 2. EHR will notity the ap,pllrant If any F-HO mea exist, An appointment fur review will be corlfirmeo <br /> approximately five pusiness days but no later than ten (10) days after rounipt of application. The files <br /> will be held for a maximum of five bwalnee$days for review. Appointment$ should be Bchidulad <br /> accordingly. <br /> 3. A file that is detiveiy b©ing worked on by PHO staff may not be immediately avoilahle for rovlew. A nev <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned in the some condition as released Will ho reorganized by EHE) staff et the expensr <br /> of the gpplicarlt. Future file reviews by the same applicant may require a ;93.00 deposit prior to reviev <br /> 51 •TENTATNI~appointment dater, must be confirmed with FH12 staff. <br /> 61, Applications received after 3:00 pm will be pracnssed the next busincsS 40Y. <br /> CONFIRMAPPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX'" (NIVALS <br /> REVIEWED YE=S NO REVIEW RATE <br /> MID 41+941 <br />