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Jul -07-04 01 :06P P O: <br /> .._. _.,, . --- ----- »�»•" Ulv ircLAVfTl1I Fy. �IH PAGE fil <br /> DATE RR ) 't'.Il <br /> (�V" SANdOAQUIN COUNTY <br /> 4 EnMotvl► ENTAL HEALTH DEPARTMENT <br /> 700 <br /> 304 Weber Ave 311 Floor Stockton,CA 9520S j <br /> 20 9 42 E 0 Fax:(209)464-0138 Web:www.co.Rm-joaquin-ca-u&/ehd `XJ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 4210 <br /> APPLICANT: &Sa.Vl Gf-PPny->w(., NUSINESSIAGENCY- <br /> *ADDRF1S: ,90fG t:•• S V m LCIS 1*/6 5Sfy CI 9'57Z6 <br /> ONf: JSal- Zy3-F �a FACSIMILE: S5q-d-q3-Y�__1,5 - <br /> T9NTATIVE'APPOINTMENT DATE: -7I2-I ( O <br /> (Pfa "allow 10 Dwlh"s days foil tlete of 11PP11CMIon S1Axn" <br /> El CHECK BOX TO EXPEDITE REOUR T-393.110 FEE-RE UEST PROCESSED IN 3 BUSINESS DAYS -71 -1 I , <br /> SIGNATURE OF APPLICANT �L/M ���� DATE tl /Vf <br /> oevarVm (the Only <br /> FILE ADDRESS UNIT <br /> 177 Unit t <br /> sadv f w' � � Unit 3 <br /> r. creel 2..j: gy ,l Pry .. Unit 4 <br /> e sues O <br /> c"' Unit5 <br /> ,o imr <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 0'/�-y 5 740 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOPI Q HOuSINC ASATFMENT 13 SOLD WASTE FACILITY <br /> OTHER CLEANUP SITE(HOK-LOP) O FOOD FACILITY 4 SOLID WASTS VEHICLE <br /> UNDERGROUNO TANK(MONITORINGMCMDVAL) a DOG KENNEL ❑ DAIRY <br /> sbHAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TRPATmENr PLANT <br /> TIERED PERMITTED FACILITY C] MOTE MOTEL <br /> PUMPER,7RUCK/YARDM.NFJiI TOILETS <br /> TATTOOIBODY PIERCING rl POOLISPA 0 LAND USE APPLICATION SITES <br /> n MEDICAL WASTE FACILITY ❑ OTHER pjffME SPECIFY) f <br /> 1. List up to ten addresses in the space above. Select the tYPe(S)of files from the list ehayo by Checking <br /> the appropriate box(es). At least one file type MUST be selected. Fsx to(2091464-013((or mail to tha <br /> Atdrass Indicated above. <br /> 2. EHD will notify the applicant it any EHD filo$exist. An appointment for review will be confirmed <br /> appIQ)days after <br /> will roximately he held for avmaximum ofdfive business ays but no ter than to"days(Of review- Appointmenntts should he sched.lipt tit appliCation. he files <br /> led <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not,be immediately available for review. A naw <br /> application may be submitted when the file is available. <br /> A. Any rite not returned In the same condition as released will he reorganized by EHD Staff at the expense <br /> of the applicant_ Future file reviews by the some applicant may requite a$93.00 deposit prior to review <br /> G. `TENTATIVE appointment dates must be confmnad with END staff, <br /> S. Applications received after 3:00 pm will be processed the next buslnees day.To <br /> 51��yI �rt�•�.,,ocr� <br /> CONFIRMED APPOINTMENT DATE TIME CeJOepj Cwt 1-7/7,n S <br /> Pfunn r <br /> DATE CONFIRMED PHONE FAX INF'" SSQ '�-Sz.( ` <br /> REVIEWED YES NO REVIEW DATE _T 1 <br /> E u�I-0W. <br /> rNlao] <br />