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02/08/2005 16:30 FAX 209 948062 2002 <br /> DATERECEIVED <br /> RECEI \V �V wV 1vi•wu` <br /> nn. SAN JOAQU1 COUNTY . <br /> �� Er(VTRONMENTAT,HEALTI�DE, CA95205 n <br /> O 304 E Weber Ave 3z"Floor Stockton, CA 95205 Ull <br /> (209) 466-3420 Fax: (209)464-0139 Web:www.co.san-joaquin.ca-us/chd <br /> FE8 0 9 2005 <br /> PUBLIC RECORDS RELEASE A.PPLICA.'IION <br /> ' tb-_'zA BUS INESSIAGENCY: <br /> ADDRESS: aJ�w 1NWf"t�•t� '55� - <br /> PHONE: FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Tune: <br /> (Please allow 10 bminess days from date of appllatlon submlUal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE--REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT f^^— "�~ DATE <br /> Deoar4nent Use Only <br /> V �v <br /> =�"(*F71LEADD;R:FS*S <br /> UNIT <br /> 1. o 0 Unit1 <br /> � dc"al <br /> _ <br /> 2. <br /> UnR2 <br /> G Unit 3 <br /> e. sveel <br /> r s UnR 4 <br /> s s� ❑ Unit 5 � <br /> 10. S�cd G <br /> -ENVIRONMENTAL HEALTH DEPARTMENT FILES �••' �' <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT id.SOLID WASTE FACILITY <br /> OTHER CLEANUP SrTE(NON-I-OP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> RD UNDERGROUNO TANK(MONrrORINC-PFMOVAL) [:1 DOG KEtINEL <br /> DAIRY <br /> JD HAZARDOUS WASTE GENERATOR O CHICKEN RANCH IB-PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOM00y PIERCING ❑ POOLtSPA IS UWO 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)or files from the list aboye by Checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0938 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHO files exist An appointment for review will be confirmed <br /> approximately rive 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. Anev <br /> application may he 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 reviey <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the nextbusiness day. <br /> GONFI,RMED,_'P•P•.bINTMENY-U'ATE'. �.�a'.•:- [IME ^{'] <br /> :: .:: .... '"RIY(ED •r.` TAX.: "✓INFCIQLS <br /> 'DPTE CONF.I.. . PHONE : <br /> 12EVIEyVED YES NO REVIEW DATE' '.•! <br /> euo�sazaoa <br />