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08/09/2004 12:13 RTC F,.r N ATES 4 12094640138 NO.936 D8 <br /> DATE REC EHD LOG NUMBER <br /> SAN JOAQUN COL NW <br /> ENVIRONWNTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3"1 Floor Stockton, CA 93205 <br /> AI}G (209)468-3420 Fax: (209)464-0138 Web: www.co.su-joaquin.ca.us/ehdq3 <br /> � v�R�N���Sy1 CEs PUBLIC RECORDS RELEASE APPLICATION <br /> p APPLICANT:~ +! BUSINESSJAGENCY._ TC A&S4 C ,- <br /> ADORES$: (n O Z dp <br /> PHONE: /25-- Z,7 k —1815 FACSIMILE: 0.2 <br /> 2 C_ {f 63- -LS <br /> TENTATIVE`APPOINTMENT DATE: y <br /> (Please allow 10 busIno9s days fmm data of applImIlon a bn <br /> CHECK BOX TO EXPEDITE REQUEST.$ FEE-REQUEST PROCESSES)IN 8 BUSINESS DAYS <br /> SIGNATURE Of APPLICANT DATE 9/� <br /> Oepar&Wnt Use Only <br /> Ell &DRESS UNTT <br /> sheet /°o yf �' �- Unit1 <br /> ' smfl <br /> 0 Wc�F. c ra Unit2 G <br /> -�-f� v.et � C �-{w ra L- • DSI�t! <br /> 6"c ON <br /> s. sty Unit 3 i <br /> OOP <br /> & Sema! .49 Unit 4 <br /> s S1nK C <br /> 9. Sonat <br /> Unit 5 � <br /> sa SoM CI <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(U"CLEANUP SITE(LOPI n HOUSING ABATEMENT `� SOLID WASTE FACILfTY <br /> OTHER CLEANUP SITE INON-4.OP) O FOOD FACILITY SOUR WASTE VEHICLE ` <br /> UNDERGROUND TANK(U0NfTORINGIREM0VALI ❑ DOG KENNEL U DAIRY l I{ <br /> It HAZMOOUS WASTE GENERATOR ❑ CHICKEN RANCH � PKU TREATMENT PLANT <br /> TIERED PERWTTED FACILITY d MOT£LIHOTEL ❑ PUMPER TRUCKFYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LMD USE APPLICATION SITES <br /> '7M <br /> MEDICAL WASTE FACILITY C] OTHER tPLEASE SPECIFY) I <br /> 1. List up to tan 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. Fax to(209)464-0138 or mall to the <br /> address I dicated above. <br /> 24 EHD will notify the applicant If any EHD files exlst. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after recelpt 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 11148 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 EHO staff. <br /> fi. Appik;atlons received after 3:00 pm Will be processed the next business day. <br /> CONFIMED APPOINTME14T DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES Iva REVIEW DATE <br /> rpfl.,�ma <br /> uv3wo <br />