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EHD LVU NUMbtlt <br /> \DATE RECEIVED - SAN JOAQUIN COUNTY <br /> ENVIRNMENTAL HEALTH DEPART <br /> I FD) <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> 209 468-3420 Fax: 209 464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> FEB <br /> 0 9 2004 <br /> ENVIRONMENT PUBLIC RECORDS RELEASE APPLICA'T'ION <br /> IT/SF /1�- E� /7 SFe�')cc S <br /> APPLICANT: �/ N/� �TcD BUSINESSIAGENCY: r ICIZS �K)� <br /> ADDRESS: I I PALI✓I QA �� /2,&Ae J QA- <br /> PHONE: <br /> A PHONE: S 3O ` 3 ZO-947-'eFACSIMILE: s- <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 bus, ss days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQU T-$93.00 FEE REf2UE�I"PROCE ED[ 3 BUSINESS DAYS / <br /> SIGNATURE OF APPLICANT <br /> � DATE <br /> Department Use Only <br /> FILE DRESS <br /> 9. <br /> -n d <br /> U <br /> NI <br /> 1. Strom .503 R4l'R a Un <br /> it <br /> 1 <br /> 2. SM J &d <br /> ]. StrtN a Unit 2 <br /> 4. Str <br /> 6 streea <br /> Uni <br /> 6. Streea <br /> ty <br /> rsu— a <br /> Unit 4 <br /> e. Stra <br /> Unit 5 <br /> Street <br /> +/ <br /> � <br /> 10. Street a <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 91 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> F7' OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YAFtDlCHEM TOILET <br /> ❑ TATTOOBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ 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 <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 <br /> TIME <br /> DATE CONFIRMED 'PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ' EHD 18-02-006 <br /> 48200] <br />