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01/20/2004 09: 55 4640138 ENVIRONMENTAL H- TH <br /> --� PACE 01 <br /> DATE RECEIVED WED <br /> SAN JOAQUIN COUNTY - EHU LUm NU,110c' <br /> W E U IIII��/JED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3d Floor Stockton, CA 95205 <br /> JAN 2 1(H41468-3420 Fax. (209)464-0138 Web: www.co.san-joaquin.ca_us/ehd <br /> ENVIRONMENT HEALTH PFRMITJSFRVI('FS TIPUBLIC RECORDS RELEASE APPLICAON <br /> APPLICANT: 5 BUSINESSIAGENCY: <br /> cA <br /> C4 (�LLAA- <br /> ADDRESS: '1, <br /> PHONE: SID --234— �rwc) FACSIMILE: 5*f O --F <br /> TENTATIVE'APPOINTMENT DATE: I IZ:?- I0`+ Time: I ) • 3 0 <br /> (Please allow 10 business days from date of applicatlon submittal) <br /> O' CHECK BOX TO EXPEDITE REOU -$93.0 – ROCESSED I 3 USINESS DAYS �I <br /> SIGNATURE OF APPLICANT fK% DATE Z O <br /> Department Use Only <br /> FILE ADDR SS UNIT <br /> sneel 00 a. ❑ Unit 1 <br /> 3. Stmt u ❑ Unit 2 <br /> a <br /> s. svee c' Unit 3 <br /> 6. Sorel O <br /> ILI'llujullill Unit 4 <br /> 0. 9Vaec <br /> 11 11 11 11 <br /> 9 Sveel G , ❑ Unit5 <br /> ta. $1rofl C�' <br /> 26 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> )& UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Cl SOLID WAR f4CILITY <br /> W OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 114 UNDERGROUND TANK(M ON ITORINGIREM OVAL) ❑ DOG KENNEL ❑ DAIRY <br /> W HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILET <br /> ❑ TATTOOIBODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> 1. List up to ten 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 indicated above. <br /> 2. EHD 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. Appolntments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by END 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 two review. <br /> 5. `TENTATIVE appointment dates must be confirmed with EHD staff, r f. <br /> 6. Applications received after 3:00 pm will be processed the next business d <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Eno aearcoc <br /> ei0rtooi <br /> JAN 20 2004 10:@1 4640136 PAGE.02 <br />