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09/09/2005 12:05 FAX 209 9480 002/002 <br /> r <br /> f D SAN JOAQUIN COUNTY - <br /> � 2005 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENb((?L+(irF 304 E Weber Ave 3'a Hoot Stockton, CA 95205 <br /> CENT HEAL(*9) 468-3420 Fax: (209) 4640138 Web: www.co.s=-joaquirLcaus/ehd <br /> PER'v)(T/SERVICES jq7 <br /> p a PUBLIC RECORDS RELEASE APPLICATION <br /> APPLIWIT: BUSINESSIAGENCY: (-C-1L\ .b Gr— I tki <br /> ADDRESS: Zd- �rIA-1�T Cj—Q T� <br /> PHONE: � �A 1`IO' ' (3 ,.l^ FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: <br /> (Flease allow 10 busine_ days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> 1` Oemrtmenl Use OnH <br /> FILE ADDRESS 'per UNIT <br /> ,. sasn Z o _ tl ❑ Unit 1 <br /> z sen o <br /> ], saes 17 10 a Unit 2 <br /> _ t, Cd r <br /> .. spa 1 ,110, Guy e)r <br /> 5, s� 3 tle W �'Unit 3 <br /> 6. Saco G <br /> 7. sow MUnit <br /> e. SYea <br /> e. sUeeL <br /> aty ❑ Unit 5 <br /> 1a, she / <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES X U.nl F U <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT EL SOLID WASTE FACILITY <br /> OTHER CLE/WUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLD WASTE VEHICLE <br /> 23, UNDERGROUND TANK(MONITORINGIREM OVAL) ❑ DOG KENNEL EL DAIRY <br /> Sr HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ILPKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ pUMPERTRUCKIYARDICHEMTOILETS <br /> ❑ TATTOO/eooY PIERCING Cl POOLYSPA 0 LAND USE APPLICATION 5TTES <br /> ❑ MEDICAL WASTE FACILrrY ❑ 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 he 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. 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 he 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 to review. <br /> S. 'TENTATNE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will he processed the next business day. <br /> nfi t7NF.�RM d-i4P (�INT1Yf ENTTJME•`.'�. ? iT--"':_ ':i - � -:•TIME ''r.^.<f��. rr <br /> ,.; <br /> DATE CONFIRMED PHONE FAX• ' "=1NrfI6,LS `s <br /> REVIEWED YES NO REVIEW DATE: :',. <br />