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EHD LOG NUMBER <br /> ATE RECEIVED ... SAN JOAQUIN COUNTY ,W <br /> RECEIVED ED HEALTH DEPARTMENT <br /> 3048 Weber Ave 3rd Floor Stockton, CA 95205 05 <br /> AUG 13 20W9)468-3420 Fax: (209)464-0138 Web: vvww.co.san-joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> 1 <br /> APPLICANT: K2I KPrN 7\)Ar(,Pc"JV BUSINESSI, t- <br /> A�GENCY: Jrr'IQA'7VS E>JVDIICONMENIAL., LN[. <br /> 3 <br /> ADDRESS: 30 CArAC-LO rJ ?49-K. 'bQ., -r1 5S .�itY <br /> O � C"rj 9 R"QX GIF 25;632- <br /> 5;63 T- <br /> c3 <br /> PHONE: 530 E"' 600-4 FACSIMILE: 5710 636 6005 r <br /> TENTATIVE'APPOINTMENT DATE: 9113ID Time: 0&-' 00 ti^4 <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-S FEE- QUEST PROCESSED IN 3 BUSINESS DAYS <br /> (((SIGNATURE OF APPLICANT p H DATE A6113104' <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 7,JJVZ Sree 21257 CouNlcy C.lus IAti C STOLgTOrV IkT 5a6 ❑ Unit 1 /n,1 <br /> f Ii7- 2 heel Sa-S �,t Ci •I 5� O:.I�,r,/ q <br /> {{ 3. SVeet 2152- .�^ �� G " aqC l- � ❑ Unit U?1`�"/! <br /> 1,t12 4. Sheet 908 •� Ci J <br /> Unit 3 <br /> 6. SVee G <br /> 7. SheN C I <br /> & Sheet <br /> 9. SVeet c. ❑ Unit 5 <br /> 0. StreM O <br /> N 14 <br /> y ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> P UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> /29 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL <br /> ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ 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 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 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 FAX INITIALS <br /> REVIEWEDYES NO REVIEW DATE <br /> END 4842406 <br /> 8/6/2003 <br />