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22/0 /2005 11:05 FAX 209 921 002 <br /> SAN JCAQM' COUNTY <br /> EN-vmoNMENTAL REAZ TH DEPARTMENT <br /> MAR 3 2005 304 E Weber Ave 3d Floor Stockton, CA 95205 I _ <br /> EWIROPih3ECVOQ9TL 68-3420 Fax; (209)464-0138 Web: NvWW.cO-sanjoaquin.oa_us/ehd <br /> PEfiVIIT/SER',IICES <br /> J PUBLIC RECORDS RELEASE APPLICATION <br /> APPL)CANT: / A��� 6 BUSINESSIAGENCY: <br /> ADDRESS: �E <br /> PHONE: _FACSIMIL.E: nw\ OhJ <br /> TENTATIVE'APPOINTMENT DATE: C]�7��Ib Time: <br /> �y (Please allow 10 Easiness days from date of application submittal) <br /> u CHECK BOX TO EXPEDrrE REQUEST-$93.00 FEE-REQUEST PROCESSED M 3 BUSINESS DAYSg - <br /> SIGNATURE OF APPLICANT DATE O VQ <br /> Oepartrnent UdO OnN <br /> UNIT <br /> FILE ADDRESS <br /> f <br /> at, Cl Unit 1 <br /> (hAi 54x! Y( G Unit 2 <br /> S <br /> 1. 9+1 <br /> 'Unit3 <br /> c <br /> fl�UnIt 4 . <br /> i, stile <br /> a 7 <br /> ctr <br /> .. ❑ Unit 5 <br /> 9. Sue <br /> 10. Sued G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> El HOUSING ABATEMENT RL SOLID WASTE FACILITY <br /> UNDERGROUND YANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE:(NON-LOP) ❑ Dom,KENNEL Z.DAIRY <br /> 21. UNDERGROUND TANK(MONITORING/REMOVAL) ❑ CHICKEN RANCH If9-.PKC TREATMENT PLANT <br /> ffi TleRE HAZARDOUS WASTE GENERATOR ❑ MOTEUHOTEL 13 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TIERED PERMT PIE FACILrTY q pOOLISPA a LAND USE APPLICATION SITEs <br /> ❑ YATTOOIDOOY PIERCING LI OTHER(PLEA SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <br /> 11 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 be selected. Fax to 209 464-0138 or mail to the <br /> address:indicated above. <br /> 2- EHU will notify the applicant if any EHD files exist An appointment for review will he 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 he scheduled <br /> accordingly. <br /> 3, - A file that is actively being worked on by EHD staff may not be immediately available for review. A nes . <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will he reorganized by EHD staff at the <br /> of the applicant_ Future file reviews by the same applicant may require a$93.00 deposit prior too mreensvie <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff, <br /> 6. Applications received after 3;00 pm will he processed the nextbusiness day. <br /> .Y'i W..,:. _,.TIME . ^7:r`.r%1 ,r+r :l.; <br /> CONTrdF;M�a APROINTMENT QATE' <br /> i Tx••'. <br /> 'DPTE,GgtlFIRMED. <br /> 4PHONE': FAX':: :;'.'( ; lNilQLs <br /> REVIEWED YES NO REVIEW DATE <br /> Eno aaayoac <br /> uennm <br />