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04/06/2_005 09:56 FAX 209 9480f"''_ R002/002 <br /> CfW WV 1\VNM+u• <br /> DATEPACENED SAN JOAQUIN COUNTY ` <br /> n"D ECENJEDD ENvmONI uruAL mALTA DEPARTmNT <br /> 304 E Weber Ave P Floor Stockton.CA 95205 <br /> APR - 6 200009)468-3420 Fax:(209)464-0138 Web:www.co-ftu-jOaquin-cLus/abd <br /> ENVIRONMENT HEALTH PUBLIC RECOnS RELEASE APPLICATION <br /> BUSINESWAGENCY: ► <br /> ADDRESS: <br /> atlaNE- <br /> .� FACSIMN_E: g� <br /> TENTATW APW"E►rr DAM' <br /> ` (PMase Shaw 10 badrA s day%troll date of applieadon sub M t BQ <br /> CMCK OMTO EOM=REQUEST-$Q Ail FW—RECIUIMT PROCRSSED IN 3 RUSINESS DAYS <br /> SIGNATURE OI:APPLICANT _, —- aaw PATE <br /> • DeWbnantUn Ckdy <br /> RN.B ADDRESS UNiT <br /> CW 2"kjhmo'? ❑ Unit <br /> N 5 <br /> una 2 +1L4-0a.... \ <br /> "e <br /> My N <br /> FF, UNt 4 <br /> n <br /> sr.o 13 M& CRYto <br /> ENWRONMENTAL HEALTH DEPARTMENT FILES <br /> utaD@RIF�ROUHQ TANK ty"cLEAmw 9rte P.OM G HOUSING ABATEMENT M.SOW WAM FACUM <br /> arrom CLEANUP WE PON4AM 13 F000 FACILRV d SOW WASTE VEHICU <br /> f uNMWRW m TANK(MgSTORMMEMOVA-) G DOG KENNEL. W DAIRY <br /> A HAZARDOUS WASTE t1lt1$MM O CHICKEN RANCH IL PM TREATMOff PLAIT <br /> O Tri PEM f iED FACILiTY Q MOTCI MOML C PUMPER TRuCV"1RDIG€M TOILET= <br /> O TwTTOQIBOO1f p{ERCWG 13 P00tlSPA OL LAND USE APPLICATION SiT M <br /> O MEDICAL WASTE 13 O OTHER(PLEB SPEC <br /> 1. Ust up to ten addresses in the space above. Select the types)of files from the list above by cheekineg <br /> the appropriate box(es). At least one file type MUST'be selected. Fax 2 464-013 8 <br /> or addrass3ndicoted ab <br /> 2. Elio Will notify the applicant if any EHO 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 Tiles <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that In actively being worked on by EHD staff may not be immediately available for review. Ane` <br /> application may be submitted whet►the file is available. <br /> 4. Any We riot returned in the same condition as released will be reorganized by EHD staff at the experts <br /> of the applicant. Future Tile review3 by the same applicant may require a$93.00 deposit prior to revie• <br /> b. "TENTATIVE appointment datas must be confirmed with EHD staff. <br /> 6. Appficatigns received after 3:00 pm wilt be processed the nextbusiness day. <br /> �l�i �►P, b1NT�11l=NTTfATi~.sr. ' :s . _,•J-WE `• Y r. <br /> rR��EVjEWFID <br /> CONF1Ri i`D <br /> FAX' .YES NO REVIEW DATE '. <br />