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��J- t4f/h <br />v 4T N*1 <br />11/08/2004 14:46 209467 ACE STOCKTON AK <br />ED SAN JOAQU IN COUNTY <br />ENmoNMIENTAL HEALTH DEPARTMENT <br />N O V 0 8 2004 304 E Weber Ave 3r° Floor Stockton, CA 95205 <br />`209_) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.eaus/chd <br />u:,;�-:.,�iVi�iiEPdT HEALTH <br />PE' IJ!!T/SERVICES PUBLIC RECORDS RELEASE APPLIC.A.TTON <br />r <br />ADDRESS: <br />EHD LOG NUMBER <br />TENTATIVE* APPOINTMENT DATE: TfnMa: nn ,,,, <br />(Piame allow 10 busmen days from data of appl s u l) OYJ&4_U <br />® CHECK BOX TO EXPEDITE REQU • I' .00 FEE — REQUEST E IN 3 BUSINESS DAYS / ( 1 / <br />SIGNATURE OF APPLICANT DATE I/ d <br />Department Use Only <br />EN t EN i HEALTH <br />ENVIRONMENTAL HEALTH DEP SES <br />NDBRGROUND TANK PAT) CLEANUP SITE (LOP) <br />THER CLEANUP SITE (NON -LOP) <br />NDERGROUND TANK (MONITORINGMMOVAL) <br />US WASTE GENERATOR <br />C3 11aRED PERMITTED FACILITY <br />O TATTOOIBODY PIERCING <br />0 MEDICAL WASTE FACILITY <br />0 HOUSING ABATEMENT <br />O SOLID WASTE FACILITY <br />© FOOD FACILITY <br />i1T <br />M DOG KENNEL <br />u <br />E3 CHICKEN RANCH <br />y <br />© IAOTELMOTEL <br />_. __, �u• l ► ,/ . lac <br />Q POOLISPA <br />'f>twa�! 9810 TEN <br />am <br />_ <br />• 1 �hrl� �1���llii ►Ti � If' <br />EN t EN i HEALTH <br />ENVIRONMENTAL HEALTH DEP SES <br />NDBRGROUND TANK PAT) CLEANUP SITE (LOP) <br />THER CLEANUP SITE (NON -LOP) <br />NDERGROUND TANK (MONITORINGMMOVAL) <br />US WASTE GENERATOR <br />C3 11aRED PERMITTED FACILITY <br />O TATTOOIBODY PIERCING <br />0 MEDICAL WASTE FACILITY <br />0 HOUSING ABATEMENT <br />O SOLID WASTE FACILITY <br />© FOOD FACILITY <br />13 SOLID WASTE VEHICLE <br />M DOG KENNEL <br />O DAIRY <br />E3 CHICKEN RANCH <br />13 PKG TREATMENT PLANT <br />© IAOTELMOTEL <br />❑ PUMPER TRUCKIYARD/CHEM TOILETS <br />Q POOLISPA <br />G LAND USE APPUCA110H SITES <br />C3 OTHER (PLEASE SPECIFY) <br />1. List up to ten addresses in the space above, Select the type(s) of flies from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (209) 46x-0138 or maii_to the <br />address (nd)cated above. <br />2. EHD will notify the applicant If any EHD flies 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 $93.00 deposit prior to review. <br />S. *TENTATIVE appointment dates must be confirmed with EHD staff. <br />61 Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED AF!PbINTMENT DATE.:, : _.:..: : TIME-- <br />; ; , _ ::.: ; :. ,:. • ..: <br />:DA'1E cvlui✓IRMED ; f?HONtw; <br />•D; YE:: <br />per:, :tNIT1A1$ <br />REVtEftQ :..: YES::._......•. .-NO Rev <br />