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lo: 1[ ylb8b10tae SECOR <br /> PAGI= eiie <br /> DATE RECEIVED COUNTY EHD LUV rV.JMUtx <br /> ,�aa�ulilCOUNTY <br /> x , ]ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304E� Weber Ave 3rd Floor Stockton, CA 952015 <br /> -� f^209j 4 8r 4 0 Fax: (209) 464-0138 Web: www.co-san-joaquin.caus/ehd <br /> NOV 0 7 2003 PUBLIC RECORDS RELEASE APPLICATION <br /> r I.NWI R UIIt! ? <br /> APPLICA" �' � Cl�;� BUSINESSIAGENCY: Srgo,� i„r,-EgddEtyGa_L <br /> ADDRESS: . 01-7 xr1( >�Js.'L S i. _ k'++r1Cri - nL -_ !A•.-� C�7r. __ <br /> PHONE:_[ap) Eto 1 :0 ann X_7_ 3 FACSIMILE:_(-2 rte4 6 _T _ <br /> TENTATIVE*APPOINTMENT DATL: (11118 Time: YOZS22 A" <br /> (Please allow 10 buslness days from date of application submittal) Fe-c' <br /> CHECK BOK TO EXPEDITE REQUEST-$93.00 FE -REQ ST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE u/7/111.3 <br /> Department Use Only 0 <br /> FILE ADDRESS UNIT <br /> ,. st.U01 ter^ , V 0Unit 1 <br /> 2. $Veer rs Lt q � M r El <br /> to <br /> a, Suest V \r�1 �► city, <br /> ? <br /> 4. St•rr 1-F _ \1 cily S <br /> s. Street 1l -e " V \J -4 Cn K7uP[3 <br /> 5. Si re et *d &iA14�1N !4 ( GIA srt k7 <br /> 7 <br /> C: <br /> e. &t7Rrl E1 Kbl Cf r C <br /> 9. Srrcn �q <br /> 10, Streei Cp <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES V% <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> IRI OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> )9L UNDERGROUND TANK(MON ITORIN GIRE M OVAL) ❑ DOG KENNEL Ll DAIRY qiiiolv <br /> t5 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 73 MOTELI•HOTEL Q PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOOIBODY PIERCING O POOLISPA Q LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY Ca 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 checking <br /> the appropriate box(es), At least one file type MUST be selected. Fax to(209)464-4138 pr mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD flies exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)clays after receipt of application. The fifes <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 worked on by EHD staff may not be immediately available for review. -A nev <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expenst <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to reviev <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 prn will be processed the next business day, <br /> CONFIRMEDAPPOINTMENT DATE TIME <br /> RATE CONFIRMED —.- - PHONE FAX ' IN(T'IALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH b 48.02-0Q6 - <br />