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11/07/2003 16:12 91686100-0 SECOP. PAGE 01/E <br /> EH[)LVID fVUMGtK <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> . x , ENVIRONNV TNTAL HEALTH DEPARTMENT <br /> /I� h 304 E Weber Ave 3" Floor Stockton, CA 95205 <br /> 1209)`48- _4�Z0 Fax. (2Q9)4b4-0138 Web:www.co.san-joaq <br /> NOV 0 7 2003 PU13LIC RE, CORDS RELEASE APPLICATION <br /> APPLICA-NVFIt'iUNI,I NT l C1�� BUSINESSIAGENCY: <br /> ADDRESS: <br /> PHONE: q1 Z FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: III!t3 _ �� Time: <br /> /J:Q7 <br /> (Please allow 10 business days from date of application submittal) <br /> Q CHECK BOX TO EXPEDITE REQUEST-$93.00 FE _REQ £ST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE a/7A.S <br /> Department Use Only <br /> UNIT <br /> FILE ADDRESS <br /> ,. s•,��1 � at a ❑ unit 1 <br /> cu er 7 <br /> 2, sveet tS` _ wa U� <br /> G �� ❑ Unit <br /> 3. Street l <br /> 4, sort Ley 4C r <br /> 5. slams `1'b Gty it 3 <br /> G. Street �! LlnICp�N i9U _�__ CItY -5710. N <br /> T. Street (y�� G� G /L)H Unit 4 <br /> G, nit 5 <br /> 9. Street <br /> CI <br /> 10. S!reet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> O HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 11 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> � OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL El DAIRY A UNDERGROUND TANK(MONITORINGIREMOVAL) 11 CHICKEN RANCH ❑ PKG TREATMENT <br /> L3 13PLANT <br /> FErHAZARDOUS WASTE GENERATOR p MOTEUHOTEL PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY 0 POOLISPA ❑ LAND USE APPLICATION SITES <br /> in TATTOOIBODY PILRCING p OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <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 299 464-0138 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 recelpt 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: A nev <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 to reviev <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> PATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> END 49.02-000 <br /> 8/812003 <br />