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11/15/2004 12:16 2094671118 AGE STOCKTON PACE 01/01 <br /> DATE RECENED EHD LOO NUMBER <br /> Sale JOAQU N COUNTY <br /> ENVTRONMENTAL HEALTH DEPARTMENT ! 3:3 <br /> 304 E Weber Ave I'd Flow Stockton,CA 95205 <br /> (209)468-3420 Fix: (209)464-0138 Web:www.co.san-joaquin.mus/ehd <br /> Y PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINE$SIAGENCY: <br /> ADDRESS: <br /> PHONE: i3l t!! 7 _lee) FACILE: 2-09 * 7--7Y <br /> TENTATIVE"APPOINTMENT DATE: __ Tame: <br /> I--� `� Mill" <br /> T�I (Please allow 10 busimm days feom dab of applMatlon submtltal) <br /> u CHECK BOX TO EX`P'EDITE REQUE$ 9.1.00 1EE--RBQU ROCESSE SWESS DAYS <br /> 01 <br /> SIGNATURE OF APPLICANT DATEG <br /> De <br /> 4"fit Usa OMy <br /> InUVADDRESS UNIT S <br /> ' ❑ Ur�t 1 <br /> El ' Unit 2 <br /> ❑ Unita <br /> 7. aftOR <br /> /QG �l`/t tCE�p rp <br /> L Lo e v o Unit 4 <br /> 10 svw E3Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> FUND TANK(UST)CLEANUP SITE(LOP) O HOINWO ABATEMENT D SOLID WASTE FACILITY <br /> 1❑ OTHER CLEANUP sm(NON-LOP) CO FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> O UNDERGROUND TANK(M►OWORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERIMHTTED FACILITY 0 MOTELIMOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> C3 TATTOOMODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITE$ <br /> C3 WAXCAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to tan addresses in the space above. Select the type($)of files from the list above by Checking <br /> the appropriate box(es). At least one file type MUST be selected, Fax-to(2091 40"13a or MR1110 the <br /> address Indicated above_ <br /> 2. END will notify the applicant if any END flies exist An appointment for review will be conffrrrtsd <br /> approximately five business days but no later than ten(10)days after recalpt of application. The files <br /> will be held for a maximum of five business days for review. Appointment should be scheduled <br /> accordingly. <br /> 3. A file that Is actively bekV worked on by END staff may not be immediately available for review. A new <br /> application may be submitted when tho file Is available. <br /> 4. Any file not returner!M the same condition as released will be reorganized by END staff at the expense <br /> of the applicant Future file reviews by the same applicant may require a;83.00 deposit prior to review. <br /> 6. 'TENTATIVE 813150hrumlat dates must be conf rtned with EHD staff: <br /> S. Applications received after 3:00 pm will be processed the next business day. <br /> CE�RiIiII�D i�pOifhlTMIeAIT t�.4Tl, -. . ' :•:... . <br /> DATE i?tINED <br /> FAX' — <br /> . <br /> '.iflitTS:: <br /> RkYIE1fYGIp YE3, ; — . <br /> i V►�i DAY <br /> sem <br />