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o - _ .,o: Uaa Matt Milnes , <br /> 09/15/2003 11:32 1. ",0139 415-458-8250 <br /> ENViRQNMENTr -EALTH 1° <br /> DATE RECEIVED` PAGE 01 <br /> -SAN JOAQM CoUNTx Ct7V LVV nvnnat <br /> ENVIRONMNTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`a Floor Stockton,CA 95205 <br /> S E P 5 2003 (209)468-3420 Fax: (209)464-013$Web:www.cO-san-joaquin.cau's/chd <br /> ='NNONMEINT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PER // <br /> APPLICANT: `IN allSINESSIAGENCY:i1�.P�rr <br /> ADDRESS: 1110 I.✓ fli y <br /> PHONE: 109 '61 01-11 L FACS ALE: <br /> TENTATIVE*APPOINTMENT DATE: Tkne: <br /> (P102sa allow 14 WlIraass days from data of applicallor+submittal) <br /> I <br /> CHECK 60X TO EXPEDITE REQUEST-593.40 E - EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE � <br /> is Danarl:M&K We C"IY <br /> E <br /> FHS ADDRESS UNIT <br /> 2 s , afy <br /> CD Unit 1 <br /> 1 Sven a l� <br /> Unit 2 �3 <br /> - . . nA 3 <br /> r. seta C Unit <br /> s. Sues. a Q Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT"FILES <br /> ,C3 UNDERGROUND TANK(USTI CLEANUP SITE(LOP) O HOUSING ABATEMENT Q SOUR WAST£FACILITY <br /> J�OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACIUTY 0 SOUO WASTE VEHICLE i <br /> f.d2',/UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL Q DAIRY <br /> JHAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH In PKG TREATMENT PLANT <br /> 0 'nERED PERIItrrrFO FACUJTY 0 MOTEUHOTEL PUMPER TRUCWYARDICHEM TOILETS <br /> 0 TATrOO80OY PIERCING 0 POOLISPA. O UNDO USE APPLICATION SMS . <br /> o MEDICAL WASTE FACILITY W OTHER(PLEASE SPECIFY) Ora t <br /> 1. Llst up to ten addresses In the space above. Select the type(s)of flies from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. EM W 9 464-0138 or mall 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 Toro business days but no later than ten(10)days after receipt ON application. The files <br /> will be held fora maximum of live business days for review. Appoint.mont6 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 salve 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.03,00 deposit pdor to review. <br /> S, *TENTATIVE appointment dates must be confirmed with EHD staff.. <br /> S. Applications received after 3:00 pm will be Processed the next business day. 1 <br /> 5k <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE - FAX: INMIALS. <br /> REVIEWED YES NO REVIEW DATE <br /> E DQE-03-bN - <br /> J <br /> rF <br />