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iv;28/2004 13:24 FAX 209 9480( X003 <br /> DATE RECEIVED SCAN JOAQL11N COUNTY <br /> ESMONTN ENTAL REALTu DEPARTMMNJ.' <br /> 304 E Weber Ave 3`I Floor Stockton,CA 95205 <br /> (209)469-3420 Fax: (209)464-0138 Web:www.Co.=_joaqiiin.caus/ehd <br /> pUBJLTC RECORDS RELEASE APpLICATTON Z00000' <br /> AP ql,, ff; )vS BUSINESSlAGENGY: Ire r, I1 <br /> ADDRESS' <br /> PHONE. '�'�S FACSIMILE• g(q car <br /> TENTATIVE'APPOINTMENT DATE: l� Ip`� Time: / :�✓ <br /> (Please allow 10 business days from date of appllcation submMal) <br /> ❑ CHECK BOX TO EXPEDrrE REQUEST-$93-00 FEE—REQUEST PROCESSED IN 3 DUSINE$S DAYS / <br /> SIGNATURE OF APPLICANT _ i� �r ^ DATE <br /> Department Use On1Y <br /> UNtf <br /> FILE ADDRESS <br /> I% El \ Q Unit 1 <br /> city -16^ <br /> 1I� f 1 _. �- sve� Cra <br /> L�.1Sor. �A z ��^ Una2 <br /> i-- s s� ockla'. Unit 3 <br /> �-5 -- VA k <br /> s. sueel 1 <br /> Unit4 . <br /> e. stretl <br /> ❑ Unit 5 <br /> Ck <br /> 9. Sheet <br /> 10, Street � - <br /> ENVIRONMENTAL HEALTH D1;PARTMENT FILES - <br /> (�l UNDERGROUND TANK(UST)CL.t ANUP SM(LOP) ❑ HOUSING ABATEMENT SOUO WASTE FACII.TTY <br /> 19 OTHER CLEANUP SITE(NONJLOP) ❑ FOOD FACILITY ❑ SOUD WASTE VEHICLE <br /> CO UNDERGROUND TANK(MONITOR1NGIREMOVAL) ❑ DOG KENNEL 0� UAiRY <br /> pl 13 CHICKEN RANCH M PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ MIOTELIHOTEL ❑ PUMPER TRUCKfYARDfC"EM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOLISPA VL LAND USE APPLICATION SITES <br /> ❑ TATTOOfUODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> — <br /> C3 MEDICAL WASTE FACILM <br /> 1. List up to ten addresses In Vie space above. Select the typ (s)of files from the list aboye�y checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 46,4-0138 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 tete(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. pras <br /> �l• Any file not returned in the same condition as released will be reorganized by EHD staff at the expe <br /> . <br /> cf 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 /> H, Applications received after 3:00 pm will be processed the next business day. <br /> TIME 7.57-. <br /> ;CONF.1,RMl D AAPOIMfMF-NTDATE <br /> 'DATE <br /> GOt�iF1RMED PHONE FAX' <br /> ' J`' '�NCf1ALS ;r <br /> REVIEWED YES NO REVIEW DATE. 1 <br /> EFin N-0z.oas - <br /> 6182001 <br />