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FROM(�E�NGE + I RACY, CA FAX NO. : 209-835-0675 Dec. 10 2004 03:19PM P2 <br /> / DrJ fREC,EIVtUhc.IV LVV IVUIVIOLI\ <br /> I�fJ_l SAIF JOAQUIN COUNTY <br /> `�'t �� IJyrllt,�,�,t, T_l� <br /> �\ P' ENVIRONMENTAL HEALTH DEPARTMENT <br /> ��C 1 Z 304 E Weber Ave 3`0'Floor Stockton, CA 95205 <br /> 9)468-3420 Fax: (209)464-0138 Web: www.co.san-'oaquin.ca.us/ehd <br /> f'Lr��•;'jI �i"ltv/(( �S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUVN2$$tAGENCY: EM 6 iE 6 <br /> ADDRESS:� o /U. 7 Acy L !2 _37K <br /> PHONE: 202- '33'5'!QC/6 FACSIMILE: 209' 335 - Q ti 76 <br /> TENTATIVE*APPOINTMENT DATE: A SA R Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.0 0 FEE-REQUEST PROCESSED 1N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �� G— -- DATE lal�lo__ <br /> Department Use Only <br /> z <br /> FILE ADDRESS UNIT <br /> poerz Ld P ECAelim ETC Unit 1 <br /> r'I;1" z. Strerl T c. G1P /7 5 <br /> P,G3. 'tG 3, Sint OO O G 7GL'► Unit 2 <br /> {w usT $trent <br /> 2S50 Lac NNN a <br /> �r <br /> d ie <br /> 6. Street 00 0 v C( ��dl✓ .. ,3'S%' <br /> .:.''y. <br /> 7. Street ci Unit 4 <br /> 8. Strert �' EM <br /> 9 street G Unit 5 <br /> tuu <br /> 10. Sheet Gry F <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP),HOUSING ABATEMENT "< OLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(M ONITORINGIREMOVAL) �OG KENNEL <br /> HAZARDOUS WASTE GENERATOP CHICKEN RANCH ��DAIRY KG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY TEL/HOTEL �UMPER TRUCK/YARDICHEMTOlLETS <br /> ❑ TATTOOIBODY PIERCING ��Pa A LAND USE APPLICATION SITES 1 <br /> MEDICAL WASTE FACILITY M 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)464-0138 or mail to the t <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 /> accordingly, <br /> 3, A file that 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 file not returned in the same condition as released will be reorganized by EHD 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 EHt? staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FA:i INIT1At.d _ <br /> REVIEWED YES NO REVIEW DATE <br /> EhD 48-02-006 <br /> IMti/2001 _ . <br />