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" OCT-08-2003 10:39 CAMBRIA 1707 935 6649 P.02i02 <br /> DATE E <br /> SAN JO,A.QUIN COUNTY <br /> I�IT <br /> �.,K�f .!! <br /> ENVIRONMENTAL HEALTH))EPARTMENT <br /> 0 C T 8 2003 fi 304 E Weber Aye 3''�Floor Stockton,CA 95205 <br /> .-NVIROWEP RA4LR-3420 Fax: (209) 454-0138 Web: www.co.san joaquin.ca.us/ehd <br /> P1 RM11'/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT:��'�a 1�14t�^iT+'7 ' n - -BuSINESs/AGENCY: t�QMAt � �_ ►. 9 �y <br /> �t ADDRESS:,z-_4c-� -,. <br /> PHONE:�_anEb 9_1�5_ �"R�t�- - FACSIMILE//: <br /> TENTATIVE'APPOINTMENT DATE: Ot'70b� r 13 Time: •ad <br /> (Please allow 7D business days from date of application Submittan <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Qs, DATE <br /> Departrnent Use Only <br /> FILE ADDRESS UNIT <br /> �. sheei Z Z. It-- e' S Go- d ❑ Unit 1 <br /> treet2-'T� <br /> 1 3 57ee� 0 ❑ Unit 2 .2 <br /> l <br /> �. ❑ Unit 3 <br /> 8. Strce1 G <br /> ? street u Unit4 <br /> e. sV*d <br /> o Slree� u Unit 5 <br /> ENVIRONMENTAL HI=ALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) TO FOOD FACILITY C3 SoU13 WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL,) 0 DOG KENNEL O DAJRY <br /> ❑ HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> Q TIERED PERMITTED FACILITY 0 MOTEL(HOTEL C3 PUMPER TRUCKIYARDICHEM TOILETS <br /> O TIERED ERM(BODY PIERCING O POOL!&PA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL.WASTE FACILITY Q OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list aboye 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 revleW. 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 ne <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 . >`00 deposit <br /> staff p therior too revie <br /> ens <br /> of the applicant. Future file reviews by the same applicant may require a$933. eposit p <br /> 5, *TENTATIVE appointment dates must be Gonfirmod with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED _ PHONE FAX. INIIIAlaS --�— <br /> REVIEWED YES No REVIEW DATE <br /> QA T$R.- <br /> 2 <br />