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11/08/2004 14:46 2094671 AGE STOCKTON PAGE 01/0 <br /> EHD LOG NUMBERM ftvFD SAN JOAQUW COUNTY <br /> ENvjRo wNl'AL HEALTR DEPARTMENT IO <br /> NO V 0 8 2004 304 E Weber Ave 3`1 Floor Stockton,CA 95205 <br /> �209 468-3420 Fax: (209)464-0138 Web:www.co.san joaquin.ca.us/ehd <br /> dTAi JNIMENT HEALH <br /> PIP 4IT/SERVICES PUB IC RECORDS RELEASE APPLICATION <br /> APPLICANT:;;32'1 <br /> USINESSIAGENCY:ADDRESS:PHONE:42n <br /> ` M107-119/J& FACSIMILE: 17 <br /> TENTATIVE'APPOINTMENT DATE: Tim: <br /> (Pibaaa allow 10 business days from data of application submittal) M�n+0 ((!y'tQ/l•1--� <br /> CHECK BOX TO EXPEDITE REOUE - .00 FEE—REQUEST ESSB IN 3 BUSINESS DAYS L/(lI f <br /> SIGNATURE OF APPLICANT DATE I1d <br /> AQq <br /> Ooparlmant Use Only <br /> FILEADDRESS <br /> snea =7 ❑ Unit 1 <br /> z sin � S <br /> 5 nae 3 1F- . a [)nit 2 <br /> 4 s T flit t t Gc? 5,,g4U ' '� <br /> p <br /> 5 SnBn 11 d. Ir <br /> a. seen on <br /> T Sb d Unit 4 <br /> e, s:a+al <br /> a. s:na CW Unit 5 <br /> m. suer <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> THEIR CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELMOTEL ❑ PUMPER TRUCK(YARDICHEM TOILETS <br /> 0 TATTOOBgDY PIERCING 0 POOUSPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST he selected. Fax to(209)464 IHSS or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD flies 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 files <br /> will be held for a maximum of five 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 require a$93.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 61 Applications received after 3:00 pm will be processed the next business day. <br /> .,uW l,a:cfai w•cw... :TIME::.: ... <br /> DATE:CONFIRMEDPHONE: ` . FAX' <br /> 1NkTJA,tS i <br /> REVIEWED YES': N0 R12ViENiUk7E. <br /> E •� <br /> elW2003�aoa <br />