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aaIF71/LdF?4 ,.1L:4/ .. .. 2US-579-2225 <br /> NIQDESTQ.ATC PAGE._ I?1 <br /> BATF RECEIVED ^ � � � `�-' � <br /> EHD LOG IVLIMBE <br /> i� i ;�� n SAN JOAQUIN COUN1'X <br /> �; ,�iL ," i�'D ENVIRON M EN-'AL <br /> HEALTH DEPARTh7[ENT . <br /> SEP 0 1 2004 304 E Weber Ave Td Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209)464013$Web:www.co.san joaquimca us/ehd <br /> � �2 <br /> trvV;`rf;,i'Jf lHEALTH <br /> PFFPUBLIC RECORDS RELEASE APPLICATION iq <br /> >�: , E 1 <br /> APPLICANT: O f,(,w V O�V \�Q.i+ BUSINESWADENCY: T C- <br /> ADoREss: t l�' L� �. ,:PQi S♦� �--� Q /`rl v S�O <br /> PHONE: FACSIMILEf: <br /> TENTATIVE*APP04NTMENTDATE. 1 l � TIM*: d9�Q <br /> (Please 8110w 10 businttse days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> 0"k-, �I e S ti S 'ova-13"', {•`: � M:i fl- f <br /> Departntant Lisa Only i <br /> FIL9 ADDRESS UNIT <br /> ,. s w, S`t do o,c< < u •+�_ S c K w U5 i AZ +OY ❑ Unit <br /> i sireeet 'S t�j'I 4c t �L s,r►.rZ 5 A1C %4 1S <br /> 35�� , s ►y �c �t4.9- 7 S}��k y ��foo <br /> �5a4 M 4 � PaL� tc t,�� S 4K -1 9r, 2 C1 Unit 2 I� 5 <br /> e: aa.a Loi k. J+k4%^ ��rr-�� <br /> a say <br /> e. Street Z � �. r-k„Al�^ [R1 . Q �C1 f-1.%f-1.% � <br /> � <br /> aty <br /> 5az-P `"e. su.a 7Z} N, V+i t.L�- a+r-t S tk un <br /> 3 5 Q Unit 5 <br /> ���-7 street / Si t,�`t►'� t�4 � 5 t , <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES � <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT o SOLID WASTE FACILITY <br /> CR OTHER CLEANUP SITE(NONE LOP) (3 FOOD FACILITY d SOLID WASTE VEHICLE <br /> W UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOCS KENNEL Q DAIRY <br /> d1 HAZARDOUS WASTE GENERATOR a CHICKEN RANCH ❑ PKO TREATMENT PLANT <br /> Jd TIERED PERMITTED FACILITY 0 MOTELMOTEL t7 PUMPERTRUCKIYARD/CHEM TOILET_S <br /> ❑ TATTOO/EODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICA11ON srrEe <br /> 0 MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) _�„�„• _ <br /> 1, List up to ten addresses in the space above. Select the type($)of tiles from the list above by Ch9*klnQ <br /> the appropriate box(es). At least one file type MUST be selected. FM!2 209)464-0138 or mall to_th2 <br /> address Indicated a <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 recelpt of application. The tiles <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A Tile that Is actively being worked on by EHD staff may not be immediately available for review. A nei <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 revley <br /> 5• *TENTATIVE appointment dates must be confirmed with EHG staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOIIUTMENT IDATE TIME <br /> DATE CONFIRMED, PHONE FAX, °.iN1Tli4>;S <br /> REVIEWED YES NO REVIEW DATE <br /> •uati <br /> erntrsaaa . <br /> rt. <br />