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06/26/2006 12:21 FAX 1M002/002 <br /> GI�J IVY• �• <br /> DA,T'c RECEIVED I Is SAN JC)AQUII( Coub'ry <br /> ENV'(PWIKENTAL HEALTH DEPAR)—LENT <br /> 304 E Weber M 3�Floor Stockton,CA 95205 <br /> uja 3 <br /> "420 Faz: (209)464-0135 Web:WWWcO-Saa-3oagwn.crLtls/ehd Z 1((// <br /> (209)46S � (((/// <br /> PUBLIC RECORDS RELEASE ?PPLICA TION��_ ��s�•, <br /> ---- <br /> APPLICANT: J- fLlc �"` p,US1NESSlAGF.NCY: <br /> 71n� MADDRES <br /> PHONE: fACSIM�It}.E/:TIENT ATNE'APPO6i"i M1ENT PATE: <br /> (Pleas allow i0 husiluw"days t,,M date of applicatiolt sutmittal) <br /> © CHECK BOY TO PXPEorrE REQUEST•$33.00 FEE—REQUEST PROCESSED 1N 3 BUSINESS DAYSDATE !1? <br /> SIGNATURE OF APPLICANT DepattmentUse Only <br /> UNiS <br /> FILE ADDRESS [� unit 1 <br /> a . Unit 2 <br /> x s� <br /> 2 M ✓ ? f 7 , r <br /> 7�F t.00 `�✓ u <br /> s t��l£iE cr S� , Unit4 <br /> ,. �• 3-r G <br /> t. SueelT�,y( �L--�s-„'o' - G -" LJ <br /> Unit 5 <br /> a, SA"d <br /> 10. +moi <br /> ENVIRONMENTAL-HEALTH DEPARTMENT FiLES <br /> ❑ NOUSINO AnATEiAENT It_SOLID WASTE VVMCfY <br /> CLEANUP SITE tLOPI ❑ FOOD FACiLfTY ❑ SOUO W ASTE VEHICLE <br /> �1 UNOERGft0UN0 TANK(ISI) <br /> p.DAIRY <br /> L'( OTHER CLEANUP srm(NONLAP) O DOG KENNEL CO-PKG rRFA"AEN r PLANT <br /> a UNDERGROUND TANK IMONiTORiNGrt3EMOVAL) O CHICKEN RANCri 0(CHE�,4 TOti-Er5 <br /> GENERA70R . ❑ MOT-CLiHOTEL ❑ LAND USEAPPUCAR <br /> a NAZARDOifS,WA57E � {Js1y0 USE APPt-ICA710H SPrE5 <br /> ❑ tTERED pERMn TED FACILITY ❑ PQOLISPA <br /> ❑ TATTO'MODY PIERCING M OTHER tPLG15E SPEUf'f) .--- <br /> m MEDICALWASTEPACILfrY of tiles from the list above py gheckin9 <br /> f List up to ten addresses in the space above. Select the type(s) <br /> the appta ten a box(es). At least one file type MUST be selected. Fax to 203 464-0133 or mail to Ehe <br /> address indicated above. EHD files exist An oppointmeat for review will t The fil•is <br /> 2 EHD will notify the applicant If a^ybut no later than ton(10) days alter receiptSOf application. <br /> approximately five business days <br /> tntmenis should be scheduled <br /> will be held for a maximum of live business days for <br /> review.bpm immediately availat+le for review. A new <br /> accordingly, worked an by EHD staff may <br /> g Able that is actively being Dose <br /> application may be submitted when the file is available, wire a $93AP Dst;)deposit Prior to review. <br /> 4. Any file not returned in the same condition acme apsed will be <br /> may reorganized by EHD stiff at the exp <br /> of the applicant. Future file reviews bystaff. <br /> 5 °TENTATNE appointment dates roust be co^c essndtthe n0 t business day. <br /> wilt be ---� <br /> 6. Applications received after 3:00 pm p �•^,yJ. rv::^Y: ;'.i<,:r:, ..' . , <br /> TIME lTii ?:;,..,.•,. <br /> POINTMENT'.dATE: <br /> :G4NF..�RMED 2 <br /> FAX'.- i.>sit�ItQ1. <br /> .•;•`; • . - ....�. <br /> 'DATE CpNFi(i4'ED <br /> REViEW DATE —;�•� —— <br /> REVIEW[D <br /> YES NO <br />