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04/15/2004 15:15 2094671118 AGE STOCKTON PAGE 01/F, <br /> �[�Ai REE�IVED,�1 ID EHD LOG NUMBER <br /> SAN JOAQUIIN COUNTY <br /> APR 1 5 2004 ENVJRONMENTAL HEALTH DEPAR'T'MENT <br /> 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> r-ikt0468-3420 Fax: (209)464-0138 Web: WwW.co.san-joaquin.ca.us/ehd <br /> SER /ICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; SUSINESSIAGENCY:A I ICR <br /> (� .D <br /> 1I Ul_ nten <br /> ADDRESS: C /t uJ l -Ag 5'" <br /> PHONE: 0 Q . V67 1,6a6 FACSIMILE:�g2j!e7• <br /> TENTATIVE*APPOINTMENT DATE: Imo: *• <br /> * <br /> (Ploase allow 10 ausiness days from date of application submittal) <br /> ip6' CHECK BOX TO EXPEDITE REQ ST-$93.00 FEE-REQUE OCE SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN DATE 7 I Q <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> �o I. o c <br /> 2. a n If - 14 <br /> y(tc,,U�iinit 1 1, <br /> CRY *3 5. <br /> 11t 2 <br /> 4. S rnaln dc � <br /> 5. 5 �' Unit 3 <br /> 6 v V M <br /> city <br /> :Un:t4 <br /> e. sweat �& - I Z <br /> 9. S+eal <br /> Crty <br /> Unit 5 <br /> +o, Enna c / <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) CIFOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) C3DOG KENNEL DAIRY �'"' ` <br /> HAZARDOUS WASTE GENERATOR 171CHICKEN RANCH ❑ PK(i TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTEUHOTEL 0 PUMPER TRUCK/YARDIt <br /> ❑ TATTOOBODY PIERCING 0 POOLISPA ❑ LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑ 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 mall 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. 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 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 review <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 /> DATE CONFIRMED PHONE.: INITIALS <br /> REVIEWED .._ . YES... NO'.. REVIEW DATE <br /> EMD 441M <br /> !1/2= <br />