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8/2005 09:58 FAX 209 9480'" T <br />CDAT(E�RECEIVED �r���� SAN JOAQUIN COUNTY <br />ENVTRo"JENTALREALT11DEPARTMENT <br />W����V/L�u <br />IN v 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br />t -PR <br />_ G 7U,W09) 468-3420 Fay. (209) 464-0138 Web: www.cosan)oagtun.ca-uslehd <br />ENVIRONMENT HEFLTH <br />BUSINESSIAGENCY: __ �l Ide r fir® p <br />uo <br />PiTBLXC RECORDS RELEASE APPLICATION <br />X1002/002 <br />cw �..o r....w... <br />ME <br />ApORESS: - / \ <br />FACSIMILE: 0,1 <br />d� <br />PHONE: ' I <br />TENTATIVE' APPOINTMENT DATE: <br />(Ptoase allow 10 husir s days from date of application submilCU) <br />0 CHECK BOX TO EXPEDITE REQUEST-s9:I.00 FEE - RFDUEST PROCESSED IN 7 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />Lu <br />lig I <br />YATA _ <br />. E T,c��► <br />o n ZU -XUnit4 <br />CAT Ci n ❑ Unit 5 <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOPI <br />U HOUSING A9ATEMENT <br />DYHER cLrANUP SITE (NON -LOP) <br />ITY <br />rONNE <br />KEENNE=L <br />LlDOL <br />LlIg <br />a UNDERGROUND TANK (MONrfORINGIREMOVAL) <br />HAZARUS WASTE GENERATOR <br />W <br />O CHICKEN RANCH <br />HI <br />EI MOTEt1HOTEL <br />IT <br />❑ TIERED PERMITTED FACILITY <br />O A <br />❑ TATTOOIBOOY PIERCING <br />❑ 7HER (oTHrR (PLEASE SPE( <br />❑ MEDICAL WASTE FACILITY <br />Ark <br />0, souo WASTE FACILITY <br />❑SOLID WASTE VEHICLE <br />Bt- DAIRY <br />19L PKG TREATMENT PUNT <br />la PUMPERTRUCKNARDICHEMTOILETS <br />tA. LAND USE APPLICATION SITES <br />s of files from the list above by checking <br />1. List up to ten addresses in the space above. Select the type( ) <br />Me appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the <br />address indicated above -1 <br />2. EHD will notify the applicant if any EH 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. Ane <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 experts <br />of the applicant. Future rile reviews by the same applicant may require a $93.00 deposit prior to revie <br />5. 'TENTATIVE appointment dates must be confirmed with EHD staff. _ <br />0, Applications received after 3:00 pm will be processed the nextbusiness day, <br />'.dATE TIME S <br />APP.OINTMENT <br />PHONE PA-X'INrfIAL <br />PS <br />DATE CONFIRMED <br />REVIEWED YES NO REVIEW DATE <br />