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Mov 03 05 03: 14p Dao Murray 408-' -5-1224 p. 1 <br /> DATE RrCEIVED <br /> NONUMBER <br /> �] EAo SAN JonQumCOUNTY <br /> ' nf <br /> E 304 E N Weber <br /> Ave 3r HEALTH DEPARTMENT ���� <br /> q,nnn(� 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> N )V - 3(-Q'468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> EWROWEN(TTNEEALT BLIC RECORDS RELEASE APxPLLICATIONPIE 4AE"rF5L__ ' r <br /> APPLICANT: I !T I 'L,/�\J �� BU(SI�NESSIAGENCV: I�l�.� `✓1�tr0/t/Vl0✓1.1�W1 J-2.YVj(tLC <br /> ADDRESS: /I�J�3�./� .y�- AoscoM AU-e I� Scu��L/�yO Sheep CA 9S-(?j J <br /> PHONE:lTL/1S I ➢"lG—�a-�O�- FACSIMILE: ��`—�)J /"-I1aT <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$�93A�FFEE/—(�R/EPUU/E�S�T PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �' V vY/V Y//V(�V Y'�V 1 DATE <br /> -- Department Use Only <br /> FILE ADDRESS UNIT <br /> Skee <br /> x sEzai <br /> S � ❑ Unit 1 <br /> 3 S et <br /> O et ❑ Unit 2 <br /> 6. S \'\\1'(' <br /> E. S".1 city \ `1 <br /> Unit „y <br /> E. SO e fllFil�,/ <br /> z Sveet Unit 4 <br /> e. Sven. sleet <br /> Bcity <br /> ❑ LIDIt 5 <br /> 10. Segel City <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> / 1 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> AOTHER CLEANUP SITE(NON-LOP) U FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> - <br /> X HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKO TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEUHOTEL 0 PUMPER TRUCK/YARDfCHEM TOILETS <br /> 13 TATTOOBODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the types)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 <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 PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 4"2.06 <br /> "rano"+ <br />