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10J28/2004 13:24 FA% 209 948nPa" lj�002 <br /> DATF^RECEIVED <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPAPTMENF <br /> 304 E Weber Ave 3'Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca_u.-.1ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT- 144.- "fit-'5114 BUSINESSIAGENCY: `44 <br /> 0RIM <br /> ADDRESS: a1 �ll/f f(� c` kfan fin, 2Ka0S_ <br /> 7 <br /> PHONE: --�7�-($ -1 (`� FACSIMILE: �� <br /> TENTATIVE'APPOINTMENT DATE: Time: 12-: <br /> -r <br /> (Ptease allow 10 business days from data of applimfion submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-�$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPUCANT DATE 1� <br /> Devartment Use 0* <br /> FILE ADDRESS UNIT <br /> 2. sve� 31 ►l, N A-or_ ❑ Unit 1 <br /> :1. saw q VAZ a k Unit 2 <br /> 54_61 33 sa-.t L1y ro SNJA <br /> 5,4- TJ- y s. s 3 no k U4 Unit.3 1\\ <br /> s. sacs 1LA00 F <br /> T. P".a- Unit <br /> svw 1 5 <br /> ¢fl Cn <br /> a. Stam ❑ Unit 5 � NN ^ <br /> 10. saes W c Cr4 c1t <br /> -ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> j& UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT R9 SOLID WASTE FACVJTY <br /> IS OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE�IEwC1�E <br /> C4 UNDFRGROUNO TANK(MON(MMNGIREMOYAL) d DOG KENNEL 12 DAIRY Y{p <br /> 15 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0- PKG TREATMENT PLANT <br /> 4 TICRED PERMITTED FACILITY ❑ MOTEL OTEI, Q PUMPERTRUCICIYARWCHEM TOR.ETS <br /> ❑ TATTOO(BODY PIERCING ❑ POOVSPA a LAND USE APPLICATION SITES (I.'.-jVJ� , Ig <br /> ❑ MEDICAL WASTE FACILITY ❑ OTIiER(PLEASE SPI;ClFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail 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 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 nem <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 /> ;DATE_GQNFJRMED :', = rIPHONE 1 AX. :,:INITIALS <br /> J <br /> REVIEWED YES NO REVIEW DATE.'--.,.'. <, <br /> EHn,a.uz oa6 <br />