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06/26/2006 12:21 FAX 1�002/002 <br /> DATE RF.GF:IVEC � � cr•"�•..v. ..,,....., <br /> SAN JDA.QUnL' C0liI`t"PX <br /> EN IRONAENTAL HEALTH DEPARL--;,Er4T <br /> ;04 E Weber Ave 3'd Floor Stockton, CA 952405 <br /> ('209)468-3420 Faz: (209) 464-0138 Web. wtiv�v.co.san-joaqu.in.mus/ehd..V3 <br /> PUBLIC RECORDS RELEASE APPLIC TION <br /> APPLaGrtNl .:M BUSINESSIAGENCY: <br /> ADDRESS <br /> PHONE, FACSIMILE: <br /> FACSIMILE: <br /> TENTATIVE'APPOIHTMENTDATE: / Time: _ <br /> (pleasc allow 10 businc:9 days from date of application sutmittzl) <br /> © CHECK BUY,TO EXPEWTE REQUEST•$93.00 FES--.REQUEST PROCESS50 IN a BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Depattmenl.Uw, Only <br /> . <br /> UNIT <br /> FILE ADDRESS <br /> �j IZ `�✓ a:r ��iC fs-Tr <br /> ELA [] Unit 1 <br /> A Unit 2 <br /> 2-9-7131 <br /> •�.� LUC)MtS Ic.fi,.,,�✓✓ ah ,�....� � Unit 3 � ' <br /> �L• :ah—ci�(F GN US'r '^/ ( Unit 4 <br /> -`nit 5 4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> U'tDER.t;ROUNI}TANK(UST)CI EANUP SITE(LOP) ❑ HOUSING A13ATEMENT [1-.sOU0 WA5TE FACIL1fY <br /> L CITHEFt CI EANLIP SITE(NONLOPt Q FOOD FACILITY 0 SOLID WASTE v5F ICi-E <br /> VAI.) G3 DOG KENNEL EI DAIRY <br /> 123- UNDERGROUND TANK(MONITORINGIAEMO <br /> 63 HAZAI�DAI:a S <br /> WATE GENFULATOR 0 CHICKEN RANCH ISI PKG T`ft�AT7�SENT PLANT <br /> Q TIERED PERMfi+Eb FACILM C1 MOTEI.M07Et. a PUMPER TZUGWYAiIDIGNE:h:�TOILE i; <br /> C TATTCWODY PIERCING d POOLlSPA M LAND USE APPLICATION Si1`mS <br /> 0 MFt0IC-AL VIA.STE FAC11-rTY CJ OTHER(PL:vLE SF�LCi1 � x <br /> 1. List up to tan addresses in the space above, Select the type(s) of files from the list abr ke>y Ghccking <br /> +;ite appropriate box(es). At least one file type MUST be 5ele:cted. Fax to {2q9) i64-013.3 or mall to t`e <br /> address indicated above. <br /> E"HD will notify the apPlicant if any EHD files exist_ An appointment for review will be rc•nfir:ned <br /> approximately five business days but no later than ten('10) day: aft>rr receipt cf appl(catior. T, e f I.s <br /> will beheld for a ma;imucn of five business days for review- Appointments should be schedul0d <br /> accordingly. <br /> 3. A file that is actively being worked on by El-(U staff may not be immediately available for review. A.110w <br /> application may be submitted when the fie is available, <br /> 4, Ally file not returned in the same condition as released will be reorganized by EHD staff atthe expense <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 depasit p;;or to review. <br /> 5 °TENTATIVE appointment dates must be confirmed with EKD staff. <br /> 6. Applications received after 3.00 pm will be processed the next*business ds y. <br /> CQNF-:ki✓?l�. D.Ap0bwftlENT'.IJAT.E _ _ <br /> .:ems ';r..l''s`• .:I':.-: .1.:T �.-_::. <br /> CIATE C4t�F.1�1r�ED :PHONE . FAX'" <br /> NEVI VlCC3 YES flp REVIE1,"I DATE <br />