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08/19/2003 13:03 209467110 AGE STOCKTON PAGE 01/01 <br /> DATE RECEIVED tr1U LVV NUMt5r_K <br /> I i SAN JO,A.QUIN COUNTY <br /> v ENVIRONMENTAL REAX.TH DEPARTMENT <br /> A,-J`� 1 ?003 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209) 464-0138 Web: www.co.san_joaquin.cauV... <br /> P LIC RECORDS RELEASE APPLICATIO <br /> APPLICANT: BUSINES�SIAGENCY:�G''j 6_100 h/,l <br /> ADDRESS: r��3 u) OQ ��OCK �D (26- <br /> PHONE: 070 iDa� FACSIMILE: Q 0? <br /> d . /-''LtLP <br /> TENTATIVE*APPOINTMENT DATE: �— lJ Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQU $93.00 FEE—REQU S PROCESSED IN 3 BUSINESS DAYSFaW <br /> VqPO <br /> D <br /> SIGNATURE OF APPLICANT ATL~ <br /> Department Use Only <br /> �OFILE ADDRESS UNIT <br /> g aI-o ,. S>rkt r7 Laom/i ❑ Unit 1 �, �. <br /> 2 Street 1 h4r �l� CI UJ <br /> J. Street CLu Q ?•/ I� , <br /> 4. Street (-Ono 61ayneAw CIN W01 <br /> 6. Stmt I CAty pni <br /> 8. Street G <br /> 7, s>n�t a • O <br /> e. Sir"t I •/ <br /> s sued C1 ❑ Unit 5. <br /> 10, Street City. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) © FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ©DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/80DY PIERCING . ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY CJ 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 feast one file type MUST be selected. Fax to(209)464-0138 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 /> 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 EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED <br /> PHONE FAX' INITIALS <br /> 1 s. <br /> REVIEWED .. YES. NO REVIEW DATE = <br /> eNo aa-az-Qas <br /> Mona <br />