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01/05/2005 09:56 20946710 �c AGE STOCKTON 0 ,QI1, � � tD SAN JOAQUIN COUNTY ��n 5 2005 ENVIRONMENTAL HEALTH DEPARTMYNT ,IAN 304 E Weber Ave 3rd Floor Stockton, CA 95205 ENVIRON E� A HEAOM L" P $ 3420 Fax: (209) 464-01.38 Web: www.co.sanjoaquin.ca.us/ehd PUBLIC RECORDS RELEASE APPLICATION APPLICANT: ADDRESS: _ 837 Shaw BUSINESSIAGENCY: 209-467-100 FACSIM?PHONE: ,. A NE` APPOINTMENT DATE: ( 149.09 oma: �� ✓ .� (Please allow 10 business days from date of application submittal) �)g ai T 1 CHECK BOX TO EXPEDITE REQUES 93.00 FEE — REQUEST ROCE,S,S�ED' IN3 BUSINESS DAYS SIGNATURE OF APPLICANT 94 usT Inc. PAGE 01/0 kHu LW Nuwlo�n 15101 DATE / y a Department Use Odly , UNIT ❑ Unit 1 L J AiL ❑ Unit 2 \� a/r l ln{f z El Unit4 ENVIRONMENTAL HEALTH DEPARTMENT FILES, r N * UNDERGROUND TANK (UST) CLEANUP SITE (LOP) LI HOUSING ABATEMENT ❑ SOL 4D 11 4STE FACILITI(( }t'9 * OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE'! DO UNDERGROUND TANK (MONITORINGIREMOVAL) O DOG KENNEL ❑ DAIRY Sl HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ElMOTF.LJHOTEL El PUMPER TRUCK/YARDICHEM TOILETS ❑ TATTOOBODY PIERCING �Va ❑ POOLSPA ❑ LAND USE APPLICATION SITES ❑ MED ICAL WASTE FAj[(JLl'1Y � �' IJ OTHER (PLEASE SPECIFY) w s of files from the list above b checking 1. �its ter 5$dresses In the space above. Select the type() Y th �ppro)r ate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the ad ex Iriolpited above. 21 EHID will notify the applicant if any EHD 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 $93.00 deposit prior to review, S. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CflNF.112tlh80 aPpOiN7M) tdTbA7E;`; TJINE bATb.GONFIRhIIbCI „' pFIOfE' FAt INITtALB REVIEWED YES NO I -REVIEW DATE FILE AD RESS 9Veet Pre c Z610 z s., 17 0 e Sri a. at! 1 -7-35 !nAA cera c S 5. em.Pir C 9VPPI -BD .e. MA) ` c ]. 1..1 aY5 D 5 46XAAO -5 w4:52Lff 9. SVPPI C 018111W11 0. Slmm C HY UNIT ❑ Unit 1 L J AiL ❑ Unit 2 \� a/r l ln{f z El Unit4 ENVIRONMENTAL HEALTH DEPARTMENT FILES, r N * UNDERGROUND TANK (UST) CLEANUP SITE (LOP) LI HOUSING ABATEMENT ❑ SOL 4D 11 4STE FACILITI(( }t'9 * OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE'! DO UNDERGROUND TANK (MONITORINGIREMOVAL) O DOG KENNEL ❑ DAIRY Sl HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ElMOTF.LJHOTEL El PUMPER TRUCK/YARDICHEM TOILETS ❑ TATTOOBODY PIERCING �Va ❑ POOLSPA ❑ LAND USE APPLICATION SITES ❑ MED ICAL WASTE FAj[(JLl'1Y � �' IJ OTHER (PLEASE SPECIFY) w s of files from the list above b checking 1. �its ter 5$dresses In the space above. Select the type() Y th �ppro)r ate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the ad ex Iriolpited above. 21 EHID will notify the applicant if any EHD 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, S. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CflNF.112tlh80 aPpOiN7M) tdTbA7E;`; TJINE bATb.GONFIRhIIbCI „' pFIOfE' FAt INITtALB REVIEWED YES NO I -REVIEW DATE