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11/02/2004 10:04 9168GIA430 SECOR <br /> 01/2004 15:10 464, ENVIRONMENTAL aLTH P, <br /> DATE RECEIVED ERD LOG, <br /> AN JOAQMN COUNTY <br /> % DVNVURONMENTAL) HEALTH pEPAR. Nx <br /> i ���V J� <br /> 304 E Weber Ave 3`d door Stockton,CA 95205 <br /> NOV 0 2 201409)469-3420 Falx: (209)464-0138 Web:www.co.san-joaquin.caus/chd <br /> ENVIRONMENT- HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> V. <br /> o 1'1 BUSINESS/ACErICY: 5QC'crr ��d�rna� <br /> APPLiC-ANT: <br /> ADDRESS:! Sol r ! Ol �d <br /> PHONE: t�1 LCv� �L4 i 0qyU FACSIIMILE: � So^SUS 0 <br /> TENTATIVE`APPOINTMENT DATE: 0-5-70V 7 kx+a: Q .'Von, <br /> (Plod---w allow 1 O business ci;r from date of ApplicaGon subm" ;J„ , 60 <br /> i�. <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 SUSNESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> DwartmrA Use 0* <br /> FnX nnart>ss uArr <br /> z i'o�, C !�1! ►'' Ej Unit t <br /> 540 <br /> F1, CKV U" t� <br /> ,. .s.� Lj <br /> s. slkeu -7 z 5 �r7 n C <br /> t. Shut (J Oaw�' 5 Unit 4 <br /> 0 Unit 5 <br /> 3 6. 9aad �c7� Lt Ly <br /> I bol <br /> llN)ARONMI=NTAI,HEALTH DEPARTMENT FIDS <br /> U 4 � <br /> 0 SOLID WASTE FACiLrrY <br /> UNDERGROUNDTANK(UST) UP SME(t^� 0 HOUSING Ag t1;NrElfT <br /> d OTHER CLEANUP SITE UST) L C) FOOD FAclLrrr 0 SOI WASTE YEHICLt Y v; �s/ °°✓ <br /> W;UNDERGMXWO TANK(VCNnI' ?.ING/REMdYl11) fa DOG iCSNN6L 0 0W(tY <br /> WINCH ❑ PKG TREATMENT PLANT <br /> [3 CHd�CF�tI <br /> W HAZARDOVS WASn GENERATOR Q M07EUH RAN a PugpER TRUCtVY/�MCHE M TOILETS <br /> D TIERED PER1Mfil Eb FAC><.rryZr tMCP USE APPMATKaN SMS <br /> E3 TATTOomdoy PIERCING 1O PI.FASE SPt GFYj <br /> d MEDiCAL WASTE FACILITY <br /> 1. List up to ten addrI In the space Dbave. Select the.type(s)of files from the rrst above by checking <br /> the appropriate box(es). Al least one file type MUST be se(acted- Fax o 209 4 38 a a e <br /> address I t e a P a appointment for r4v1®w will be confirmed <br /> 2. EHD will notify <br /> the pllcant ff any EHD filar exist. to app°' after receipt of application- The files <br /> approximately live business days but no later than ten(10)days p <br /> r�fili be held for maximum of five business days for review. Appolydivients should be scheduled <br /> ficcordingly. <br /> 3. A filo that is actively being Worked on by EHD staff may not be immediately available for review, A ts2w <br /> application may be submitted when the file is available. <br /> q. Any fila not returned uthe e Same ws bytion as released will be reorganized by Et-ID staff at the 6XPI <br /> the same applicant may require a$93.00 deposit prior tore review <br /> of the applicant. F <br /> 3. 'TENTATIVE appointment dates must be confirmed with i;HD staff. <br /> g, Applications received after 3:00 pm will be processed the next business day- <br /> QNF1lMb., IPPbIN`thhENT DATE <br /> F. 1 <br /> � t�E FAX•. <br /> 'PHb •1i�11`i' Ls ` <br /> C1A'TE GON�1RM�ff - ' r I <br /> iViE1NED YEs NO REVIEW DATE. <br /> t:HO 49.aw 008 <br />