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1 ;28/2004 13:24 FAX 209 9480r"' 003 <br /> DATE RECEIVED SAN JOAQU Ni COUNW <br /> ENVIRONMENTAL HEALTH DEPARTMMNT <br /> 304 E Weber Ave 3d Floor Stockton, CA 95205 <br /> (209)469-3 420 Fax: (209)464-0138 Web:www.co.san-joaq11iu.ca.US/ehd.Z <br /> PUBLIC RECORDS RELEASE APPLICATION 0000e) <br /> APPLICANT: Even����5 BUSINESSIAGENCY: <br /> ADDRESS <br /> PHONE _ FACSIMILE: �gI qq-6 <br /> TENTATWE'APPOINTMENT DATE: lIII DoH Time: <br /> (Please allow 10 business days from date of appiic2uon submittal) o� <br /> ❑ <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 6USINESS DAYS M <br /> SIGNATURE OF APPLICANT IY `" DATE 1 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 9 a 1Ft,f11•\ 21 � a p Unit t QA <br /> Z sulelet G cSokas- -U,;� City �^ <br /> -Co-- q( . L3,v., Lint Unit 2 <br /> Unit <br /> o,kms. 3 <br /> s, ` <br /> s. s+rcel 1 t <br /> Unit 4Cky <br /> . <br /> e. sa�et <br /> 9. stun t] Unit 5 <br /> 10, sexed <br /> ENVIRONMENTAL HEALTH MARTMENT FILES <br /> (Z.UNDERGROUND TANK(UST)CLEANUP SrM(LOP) ❑ HOUSING ABATEMENT 4M SOLID WASTE FAC4LFTY <br /> ❑ SOLID WASTE VEHICLE <br /> M OTHER CLEANUP SITE(NON4.OP) ❑ FOOD FACILITY \ <br /> M UNDERGROUND TANK(MONITORW-URiEMOVAL) ❑ DOG KEHIIEL 0L DAIRY V\ <br /> J4 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH a PKG TREATMENT PLANT Q <br /> ❑ TIERED PERMnTED FACILITY ❑ MOTELMOTEL PUMPER TRUCKtYARDICHEM TOILETS <br /> ❑ TATTOO/BOOY PIERCING ❑ POOLISPA §1L LAND USE APPLICATION SITES v <br /> O MEDICAL WASTI_FACAMY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten Addresses in the space above. Select the type(s)of files from the list above py checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 46;4-0138 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 eonfnned <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 fire 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 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 requite 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 /> :CONFI,RMDPOIAiTMdENTUATE `r - '"= `_ TIME <br /> :'DATE OQNFIRMED ` `�PHONE . FAX'' : +''= NfffALS r <br /> REVjEVVED YES NO REVIEW DATE. <br /> Erin b-0zaac - <br /> srarzoo, - <br />