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06/25/2004 13:52 20946710 AGE STOCKTON PAGE 01/0 DATE RECEIVED._ D� �IS,iI\'t�/ IC IUB SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT JUN 2 5 20(20 304 E Weber Ave P Floor Stockton, CA 95205 9) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd ENVIRMMENT HEALTH nrnr.nIT;C EM11(`CC PUBLIC RECORDS RELEASE APPLICATION APPLICANT:-t,Q1[Jln LtfV _ BUSINESS/AGENCY: EHD LOG NUM 0 3 ADDRESS: 6DI n LIQUl Q PHONE: D 7 FA�,C�,SfM,,II,LE:: �a / I)r1 TENTATIVE* APPOINTMENTPATE: (.kQ. 3a_jun9 Dy Tlma: Or ti1n (Plaaso allow 10 buslnass days from data of application submittal - I nw �{ CHECK BOX TO EXPEDITE REQ UE 83.00 FEE - RE UEST PROCESSED N 3 8US(NE$$ DAYS SIGNATURE OF APPLICANT DATE department Use Only ENVIRONMENTAL HEALTH DEPARTMENT FILES UNIT ❑ Unit 1 Unit 2 Unit nit 4 ❑ Unit 5 �* UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT d SOLID WASTE F r; OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑SOLID WASTE V#kC►,� A UNDERGROUND TANK (MONITOR]NGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY•. HAZARDOUS WASTE GENERATOR E1 CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTELJHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS 4 TATr00/BODY PIERCING ❑ POOLI$PA. LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACIUTY ❑ OTHER (PLEASE SPECIFY) 1• List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(as). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the Address Indicated above 2• EHD 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 $93,00 deposit prior to review, 5• *TENTATIVE appointment dates must be Confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day,'; t CUNI;Im lzu APPOINTMENT DATE TIME DATE CONFIRMED PtEVIEWED er 2M3 YES NO PHONE FAX REVIEW DATE INITIALS W? Ir -W14 6MENW, i � ,o 1 W 01TA 1110MINVIII V%LWIIA1l10901110gq I 1 : 1 ENVIRONMENTAL HEALTH DEPARTMENT FILES UNIT ❑ Unit 1 Unit 2 Unit nit 4 ❑ Unit 5 �* UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT d SOLID WASTE F r; OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑SOLID WASTE V#kC►,� A UNDERGROUND TANK (MONITOR]NGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY•. HAZARDOUS WASTE GENERATOR E1 CHICKEN RANCH ❑ PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY ❑ MOTELJHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS 4 TATr00/BODY PIERCING ❑ POOLI$PA. LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACIUTY ❑ OTHER (PLEASE SPECIFY) 1• List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(as). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the Address Indicated above 2• EHD 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, 5• *TENTATIVE appointment dates must be Confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day,'; t CUNI;Im lzu APPOINTMENT DATE TIME DATE CONFIRMED PtEVIEWED er 2M3 YES NO PHONE FAX REVIEW DATE INITIALS