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SEP 16 '03 09:43AM COS-NJD ENGINEERING P.1/1 <br /> DATE RECEIVED LV NNW/ EHD LOG NUMBER <br /> SAN�OAQUIN COUNTY <br /> ENVIRONMENTAL]HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton, C..,A.95205 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.co-san-joaquin.ca-us/ehd <br /> ' pUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:ABUSINESS/AGENCY: U <br /> ADbRESS: dx I lO <br /> PHONE: 2,0f— J3 7—B 76 7 FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Phase allow 10 business clays from data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93 00 FEE QUEST PR=ESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT h 1166 DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> stroel / cit O ❑ Unit 1 <br /> 2. sveet c' <br /> 3. Elmet42iiij.4G ❑ Unit 2 <br /> 4. S4ree1 1 <br /> s slraot ❑ Unit 3 <br /> 8, Street Cit <br /> r streek c ❑ Unit 4 <br /> ar <br /> 8, 5treel Unit 5 <br /> 9. Slroel CI ❑ <br /> CIL <br /> 70. Slreo <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ktUNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> C3 SOLID WASTE VEHICLE <br /> C3 OTHER CLEANUP SITE(NON-LOP) 171 DAIRY <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) n DOG KENNEL <br /> a HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERnMTTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOLJSPA ❑ LAND USE APPLICATION siTEs <br /> 1;1 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 4640138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EMD 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 /> GONFIRM W,APPOINTMENT,DATE "' TIME' <br /> DATE CONFIRMED I PHONE' F%#X INITIALS <br /> REVIEWED ,YES. NO REVIM'IDATE-.;'' <br /> EHD 48-02-006 <br /> 61812003 <br />