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e`er 05/16/2005 MON 10:22 FAI ""' 472 7986 Merum-Crabtree-Brown 8001/001 U Y OT 1y/ FD SAN JOAQUIN COUNTY EHD LOG NUMBER ENVIRpNMENTAL HEALTH DEPARTMENT 17(077 MAY 1 6 2005 304 E Weber Ave 3rd Floor Stockton, CA 95205 (209) 468-3420 Fax: (209) 464-0138 Web: www.co.san-•joaquin.ca.us/chd EWRONMENT HEALTH PEWI ,FUiCES PUBLIC RECORDS RELEASE APPLICATION ,�PPLICATIO APPLICANT: 6 J!Ll %. (_SII{hnr; 110- BUSINESS/AGENCY: He LLn1 Cl -(JA -Ce, 13r('q.0 P) W v H>N TENTATIVE' APPOINTMENT DATE: Tlmc: (Please allow 10 business days from date of application submittal) M I �Gv CHECK BOX TO EXPEDITE REQUEST-S9}A04-FLEE �tEqES �D IN 3 BUSINESS DAYS DATE 6 ll&, I05- Depanment Use Or* 5. Ii709 ENVIRONMENTAL HEALTH DEPARTMENT FILES ❑ Unit t ❑ Unit 2 Unit 3 K Unit 4 ❑ Unit 5 ) .UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOUSING ABATEMENT ❑ SOUO WASTE FACILITY Y(A .j THER CLEANUP SITE (NON•LOp) ❑ FOOD FACILITY E7 SOUD WASTE VEHICLE l UNDERGROUND TANK (MONITORINGIREMOVAL) O 171DOG KENNEL DAIRY HAZARDOUS WASTE GENERATOR El CHICKEN RANCH ❑ PKG TREATMENT PLANT TIERED PERMITTED FACILITY O MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS 0 TATTOOIBODY PIERCING O POOLISPA ❑ LAND USE APPLICATION SITES 0 MEDICAL WASTE FACILITY O 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(es). At least one foe type MUST be selected. Fax to 209 464-0138 or mall 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. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE Dro".01404 — aa2003 �f- I blc,?j - le(f- tim k-" �� " cq�.t,tici Dees SkeW<✓I� urVi /O /4�P5,t• �SapSJZ r-6 II -I %UMl FILE ADDRESS ..ann I� 5 5 ea i r'. Si. , My T 2. abets a a. s.na 4. seem s. serer CRY a, swam T, aVoel a. of a. a ee to. 1. ay 5. Ii709 ENVIRONMENTAL HEALTH DEPARTMENT FILES ❑ Unit t ❑ Unit 2 Unit 3 K Unit 4 ❑ Unit 5 ) .UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOUSING ABATEMENT ❑ SOUO WASTE FACILITY Y(A .j THER CLEANUP SITE (NON•LOp) ❑ FOOD FACILITY E7 SOUD WASTE VEHICLE l UNDERGROUND TANK (MONITORINGIREMOVAL) O 171DOG KENNEL DAIRY HAZARDOUS WASTE GENERATOR El CHICKEN RANCH ❑ PKG TREATMENT PLANT TIERED PERMITTED FACILITY O MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS 0 TATTOOIBODY PIERCING O POOLISPA ❑ LAND USE APPLICATION SITES 0 MEDICAL WASTE FACILITY O 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(es). At least one foe type MUST be selected. Fax to 209 464-0138 or mall 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. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE Dro".01404 — aa2003 �f- I blc,?j - le(f- tim k-" �� " cq�.t,tici Dees SkeW<✓I� urVi /O /4�P5,t• �SapSJZ r-6 II -I %UMl