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06/27/2005 11:35 FAX 209 9480621 002/002 <br /> ,DATE RECEIVED ( SAN JOAQUIN COUNT' <br /> ENVMONNIENTAL HEALTH DEPAK MEYT <br /> IN 304 E Weber Ave P Floor Stockton, CA 95205 <br /> 3U)d 2 1(700$468-3420 Fax: (209)464-0138 Web'.wWW_cD.san-joaquin-MUS/ehd <br /> Elvi"ONMENT"EALN PUBLIC RECORDS RELEASE A PLICATION <br /> APPLICANT; A•., �!� BUSINEsSiAGENCY: 1 <br /> f <br /> ADDRESS: • Z __ <br /> .FACSIMILE:PHONE: 44 <br /> w <br /> TENTATIVE`APPOINTMENT DATE: ♦Jl� ,was ,Time= <br /> (Please a11aw 10 busl^a«days from date Of application submWzl) <br /> ❑ CHECK BOX TO Expen1TE REQUEST•597.00 FEE-REQUEST PROCESSED IN 3 BUSINE55 DAYS y <br /> SIGNATURE OF APPLICANT^ DATE, <br /> L (� Dec nt use Only <br /> ✓� P• w w O w <br /> FILE ADDRESS <br /> UNIT 5 <br /> 53 c F Unit 1 <br /> a; 1515 tnsr HW tl <br /> z su+ USr <br /> s� • a "Li Unfit 2 <br /> �� <br /> Unit 3 <br /> fi. aYaa <br /> 7. fi Unft 4 <br /> e. sa a <br /> . a L.-_ 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> K.SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)cLEmuP srm(LOP) a HOUSING ABATEMENT 0 SOLID W ASTE VEHICLE <br /> OTHER CLEANUP SITE(NUNtOP) ❑ FOOD FACILITY <br /> MONITORINGlREMOVAL) ❑ .DOG KENNEL &DAIRY <br /> � UNDERGROUND TANK( g_.PKG TREATMENT PLANT <br /> Z HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH <br /> 0 MOTEIJHOTEL 0 PUMPERUSE APPLICATION <br /> SIT TOILETS <br /> ❑ TIERED PERMITTED FAGILnY ®, LAND USE gPPUGATION 51TES <br /> 0 TATTO0(9oDY PIERCING 0 POOU'SPA <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECI <br /> 1. List up to ten addresses.in the space above. Select the type(s) of files from the list above py checking <br /> _ the appropriate box(es). At least one rile type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> addressindicated above. <br /> 2, EHD Yvill notify the applicant if any EHO files exist- An appointment for review will he 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. Y g y not be available for review. A ne' <br /> 3. A file that Is active) being worked on h EHD staff may Y <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 <br /> ere ns <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior <br /> ie <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 5. Applieatlons received after 3:00 pm Will he processed the next business day. <br /> RM I `AP>,POINTM f' w': <br /> TIME <br /> „ sS •':;:iJ:''Yjsr :«;; . <br /> CONF:>, P,D. ENT"pA7E 'i : :v:r:;'•�.;<'.::.. <br /> •` ;;,.. k:PHONE . FAX.: •' :.. .,rw'IhIFT:1f�l=S <br /> 1pAT.E,GtONF,I,Rh1ED y <br /> REVIEWED YES No REVIEYV DATE' _ <br />