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02/22/2005 13:08 KU 209 948062' <br />X1002/002 <br />- DAT1r RECEIVED Cnv evv nv.••..,- <br />SAN JOAQUI.N COUNTY <br />ENVTRONMENTAL HEALTH DEPARTMV1 T <br />(11� <br />`FFFE:��Floor Stockton, CA 95205 <br />n <br />304 E Weber Ave 3`� 468-3420 Fax: X209) 464-0138 Web., www.co.san-loagwn.caus/ehd <br />E <br />/0,95 PUBLIC RECORDS RELEASE APPLICATION <br />�'l. 4alA•t�I �l(4�'v. ia.. >. t., !, e�.rsl�G�Jr%�1�: GlJP!V. /�/.O .ri-�irl.;... <br />ADDRESS.'yf m x4 I L.L .✓� V r rm f�'+ <br />'124 PHONE n` i - -- - FACSIMILE: ~ Z>& a1 <br />TENTATIVE' APPOINTMENT DATE: <br />(Please aliaw 10 buzuVss days frort date of application submittal) <br />CHECK BOX YO EXPEDITE REQUEST - $93.00 FEE — REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT _ DATE <br />Depautmert Use only <br />N'-4 FILF ADDRESS - — <br />�i�) q�= <br />►� 2430 crfu <br />H+� 1Li5 ,. s,..a G0.►l�.rrC �r q --AQ " <br />C . a- SUecv <br />s- suce� <br />�. saroei c <br />flv!�14P JL <br />-- <br />Cscv <br />10, sk--i <br />FNVIR,C)NviENTAL HEALTH DEPARTMENT FILES <br />UNIT <br />❑ Unit 1 <br />[B Unit 2 <br />Unit 3 <br />Unit 4 <br />❑ Unit 5 <br />tl <br />W4if(,,� , <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT EL SOLID WASTE F ILMY <br />n eo -y G Aue 10 errc nrnnT . rVn r! FOOD FACII-FrY ❑ SOUD WASTE VEHICLE <br />a UNDERGROUND TANK (M ONITORINGlREMOVAL) ❑ DOG KENNE1. 19DAIRY <br />❑ CHICKEN RANCH 9-PKG TREATMENT PLANT <br />0 TIEREHAZAD <br />WASTE GENERATOR ❑ MOTELIKOTF.L Q PUMPER TRUCK/YARD/GHEM TOM -EM <br />❑ TIEREO IBODYPERMITTED FACILITY ❑ POOL/SPA 15 LAND USE APPUCA'noN SITES <br />❑ TATT00190DY PIERCING <br />1. List up to torI�.+rIrp<cot 'n the sn�e . above. Select the types) of files from the list aboye by checking <br />the appropriate box(es). AL yeast one file type MUST be selected. Fax to (2091464-0138 or mail to the <br />address indicated above. <br />2- EHO 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. Appointments should be scheduled <br />accordingly. . <br />3. A file that is actively bl�! ing worked on by EHD staff may not be immediately available for review. A neo <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 expens< <br />of the applicanL Fi fa re riie reviews by the same applicant may require a $93.00 deposit prior to revie, <br />S. 'TENTATIVE appointment dates must be confirmed with EHO staff. <br />6. Applications received after 3:00 pm will be processed the next business day. <br />:'IiINIRMER. �A,�,'VI:Y ., 7C ST+.a _ - f N _.IMF __ r�k •�..�.. 'f.`• - <br />*�, r. <br />FAX-. :,r�•lNti`EALS ;+ <br />:DATE -CONFIRMED PHONE z <br />'REVIEWED YES NO REVIEW DATE: <br />—e.1 <br />