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06/17/2004 08:44 FAX 209 948' 1 Z 002 <br /> ..•E®'P eHG LOG NUMBER <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JUN 1 7 2004 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 85202 <br /> ENyRONI MENT HEWH (209) 4683420 <br /> MIVSERVICES PUBLIC RECORDS RELEASE APPLICATION 59 <br /> APPLICANT �J("I Lk—is' 13USINESSIAGENCY <br /> ADDRESS Z`OL\ <br /> PHONE 41141 11`{1 __FACSIMILE afq{1 -O <br /> TENTATIVE`APPOINTMENT DATE 4h q TIME <br /> ZJ� <br /> (Please give T to 10 business days from a4te of aPPllcation submittal • <br /> 13 CHECK BOX TO EXPEDITE REQUEST-507.00 F -REQU T OCESSED IN 3 BUSINESS DAYS Los / V <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> LETHIS <br /> ADDRESS SIDE EHD S7AFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> pit - t9-DO <br /> r1 0.1 19 � 0Z <br /> ENVIRONMENTAL HEALTH DNISION FILES <br /> OF UNDERGROUND TANK(UST)CLEANUP SITE(LOP} ❑ HOUSING ABATEMEHT b SOLID WASTE FACILITY <br /> O FOOD FACILITY ❑ SOLID WASTE VENICI JF - m <br /> §it OTHER ROUND SITE(NON-LOP) 1] DOG KENNEL 19 PKGDAIRYTREATMENT SLA / <br /> UNDERGROUND TANK FNERAORINGlREMOYAL) O CHICKEN RANCH - Cl pKG TRCPLANT <br /> 0 TIERED <br /> UMITTED GCILITY OR Q MOTELIHOTEL Cl LAND Ft USEAPPLiCAnONSIMTOILETS, <br /> Q TIERED PERMUTED FACILITY O P60USPA ., . 61 'LAND USE EASE sPTION ABO I <br /> TES <br /> ❑ TATTOOIBODY PEIRCING dip PUBLIC WATER SYSTEM ❑ OTHER(P �EA`+E SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <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 typo MUST be selected. Fax t02 9 4644QJ38 D ail tot e <br /> address Indicated above.. <br /> 2. EHD will notify the applicant If any EHD files exlsL 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. y 0 y available for review. A net <br /> 3. A file that is active) being worked on by EHD staff may not be immediately <br /> application may be submitted when the file is avallable. <br /> 4. Any file not returned In the same condition as released will <br /> mayrequire rzed a by E deposit t prior ere nSi <br /> of the applicant Future file reviews by the same app Y <br /> S. '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 /> CONFIRMED APPOINTMENT DATE TIME <br /> PHONE FAX INITIALS <br /> DATE CONFIRMED <br /> REVIEWED YES NO REVIEW DATE <br />