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JUN-1'/-2005 16:19 AoNwNTAL <br /> R EARTH TECH 209 532 0773 P.02 <br /> aAIV d VA Y UMy %_ tj U1141 x <br /> HEALTu DEPARTmENT <br /> r�1 304 E Weber Ave PStockton, CA 95205 1S <br /> (1 ?0>�g9)468-3420 Eau: (209)464-0138 Web:eb: www.co.san-joaquin.ca.us/ehd 6 <br /> 0 <br /> iNVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> SRP l`7 <br /> �p - / — t� <br /> APPLICANT: r AYt1 S6 17a c BUSINESSIAGENCY; 04XIJ�ng- E;✓5ayH C- IAS_ <br /> ADDRESS: LAP.E <br /> PHONE: e2d,7 FACSIMILE: 0'209• 3 0�. Cy•� <br /> TENTATIVE'APPOINTMENT DATE: n2oo Time: <br /> (Please aflow 10 business days from A,of application submittal) <br /> C3 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED INrni3 BUSINESSDAYS <br /> DDAYYS(� <br /> SIGNATURE OF APPLICANT (r�11111 11 I U 11 i 111131�Mf)TE <br /> Deoenment Use Only V� <br /> \ FILE ADDRESS - 2 M UNIT <br /> IST 1. so-eOl I a ,Y <br /> �F <br /> C] Unit 1 <br /> �.U5T 3 saes IO a <br /> �I � Unit 2 <br /> �. snm a <br /> u5 s_ sve = us FiR( Ve. a <br /> Q' Unita <br /> 6. svew 94- S. Ave. a JJJ--- <br /> us Sl RaItc, Ave. city Unit 4 <br /> a. 9o- '710 S ;a- <br /> VN lW W. ❑ Unit 5 <br /> 10. sie 9 Q' 5 . &k-fon <br /> ENVIRONMENTAL HEALTH DEPARTMENT cFIILLES �efi <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Ci HOUSING ABATEMENT ,y`SOLID WASTE FACILITY <br /> OTHER CLEANUP SrTE(NON-LOP) ❑ FOOD FACILITY '�P,S/SOLID WASTE VEHICLE <br /> 9+ <br /> UNDERGROUND TANK(MONITOPJNGIREMOVAL) ❑ DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YAROICHEM TOILETS <br /> 0 TATToofaoDY PIERCING ❑ POOLISPA JIB-LAND USE APPLICATION SITES <br /> )a MEDICAL WASTE FACILITY P OTHER(PLEASE SPECIFY) <br /> 1. List up to ton 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 Indlcateif above. <br /> 2. E-HD 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 /> E U41-006 <br /> MUM <br /> TOTAL P.02 <br />