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04/06/2005 09:56 FAX 209 94806- ", �C 11002/002 . <br /> DATE RECEIVEa <br /> SAN JOAQUhN COUNTY <br /> FREC�EVED ENIMOME TTL REALT11 DFP�TrlENT <br /> 304 E Weber Ave P Floor Stockton, CA 95205 <br /> 6 ?.OW09)468-3420 Fax: (209)464-0138 Web: www.co4z�-joaquin.c&us/ehd <br /> E, <br /> :i <br /> I &ZR7 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE ARPLICATION <br /> �xan ,5_�`t�- BUSINESSIAGENCY: <br /> ADDAPPRESS.- <br /> PHONE: FACSIMILE: " oit <br /> TENTATIVlP'APPOINTMENT DATE: Time; Ic <br /> {please allow 10 husiness days from date of application submittal) <br /> �r I <br /> CHECK BOX TO EXPEDITE REQUEST-$93.010 FEE—REQUEST PROORSSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE §6 LzAL <br /> • !� DtpafinentUise Only <br /> FILE ADDRESS I UNIT <br /> 1dZbiAq4hA S+ftg-+ all =Zkrm OCAoZ [] Will <br /> L Sheet 140 G <br /> S. s� a• " Urllt 2 -4, SkwA <br /> �•'1 u'�5 <br /> ��%�� +F[�`�."3.. <br /> WKI <br /> 6- art" MAM G n O[ 00.0Irr <br /> r. s L IV P , Unit 4 <br /> e. s '3 Db kR vc My `1 l <br /> 11 Una <br /> ta- snm ✓t a a� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FIDS <br /> !I <br /> UNDERGROUND TANK(UST)CLEANUP 517E(LOP) CI HOUSING ABATEMENT &L souD WASTE FACILtrY <br /> CWHER CLI-AWUP SnV MaNlUP1 0 FOOD FACILITY 0 SOU11 WASTE VEHICLE <br /> I& UNDERGROUND TANK(MONffORIKGJRE7AOVAI-) Cl DOG KENNeL !' Is-DAIRY I <br /> AS HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH IS-PKG TREATMENT PLANT <br /> 0 TIEUD PERMrrMU FACILITY © MOTELIHOTEL A PUMPEIiTRUCKIYARDICHEMTOILL76 f <br /> u TATTO019ODY PIERCING 0 POOL/SPA M LAND USE APPLICATION SITES E <br /> 0 tArjeDICAL WASTE FACOSIY 0 OTHP-R(PLEASE SPECIFY)-. <br /> 1, list up to tan 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. Pax to 209 46.4-0138 ar mail to the <br /> address-indicated above- 'j <br /> 2. EHO will notify the applicant if any EHD files exist An appointment for review will be confirmed i <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. :f F <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A nes <br /> application may be submitted when the file is available. !E <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the experts <br /> of the applicant. Future file reviews by the same applicant rt ay require a $93.00 deposit prior t0 revie' <br /> S. '"TENTATIVE appointment dates must be confirmed with EHp staff. <br /> 6. Applications received after,3:00 pm will,he processed the nextbusiness day. <br /> A <br /> CONFIRMQ iAP,POlh1TAi1NT'�Af _ ',� yM•� TIME _ `rr'ya�-'.,:''r';� _ <br /> DATE CONFLFtIW>=D 1'PHO"NE - PAX '%1NfT1AL5 - <br /> . <br /> REVIEWED YES NO REVIEW DATE - <br /> .l <br /> I <br />