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i <br /> -----0,x/19/2005 12:56 FAX 209 94806 U002/002 t <br /> DD SAN. JOAQtTIN CouNrY <br /> FNymoNwmNTAL F1ALTH DE11ARTMXNT <br /> SEP I q 2005 <br /> IN 13 <br /> 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> 209) 468-3420-'ix: (209)464-0138 Web: www_co.saa joagUia.Ca.uddLad i <br /> ENVIRONMENT HEALTH 19 <br /> p`EG�vjlTJSERVICES pUB,LIC RECORDS RELEASE AYPLICATION <br /> I Ali' <br /> i <br /> AF'PLICAMT: 6US1NESSIAGENCY:, <br /> ,s,F�I�ss• <br /> FACS1MlL.E• <br /> s <br /> TENTATIVE'pppOINT1'IENT DATE: ThnA: <br /> {Please allow 10 business days from date of sppficatlon submltta9 <br /> Q CHECK BOX TO EXPEDITE REQUEST,593.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS S' <br /> SIGNATURE OF APPLICANT JeA DATE <br /> • - <br /> peoartirft-a Use Ordv i <br /> urclr <br /> FILE AVOPM.SS <br /> 1. sre� I'Z'7 f ra ❑ Unit 1L MMI <br /> f <br /> ANA rax Unit 2—Nbih .07.5 M <br /> [a <br /> 1AAM �,��, � � Unit 3 <br /> s. sic f/ <br /> Un>4 � <br /> z <br /> 4 ❑ Urft 5 <br /> t <br /> ' I <br /> -ENVIRONMENTAL HEALTH DEPARTMENT FILES 1 <br /> O H0115I14G AHATcbeEtrT 5L SOLID wASTE FACILLTY <br /> Ul•IOEiRUROUND TANK(IJST)CLEANUP SITS PC a FOOD FACILrry ❑ SOLID WASTE YENICLE f <br /> 'x GTjjF_R C1_�UP SrrE{NONLOP} DAIRY ? <br /> 3 M UNDERGROUNR TANK(NIONITOFUNGIREMOVA.) A DOG KEHNt;L <br /> i ffi HAZARDtai1S WASTI;GENERATOR M CHICKEN RANCH �PYCG TR EA TIENT PLANE <br /> TIER£D P>R1NrITEo FAGIL7IY in MOTELIHOTEL L3PUMPERTRUCWYARDICHEMT0iLM <br /> C1IBa01f PIERCING ❑ POotiSPA M LAND USE APPLICAmoN SITES <br /> C1 TA-r-MRIED <br /> 0 mEmCALWASTE FACILTY ❑ OTHER(PLEASE SPECiFf) � <br /> 1. List up to ten addresses in the space abave•'Select the tYPe(a) of files from the list above�y checking <br /> the appropriate ba qes). At least one file type MUST be selected• Fax to 2D9 464-013B or mail tQ the <br /> address indicated above. <br /> 2• EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> approxirrlateiy rive 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 14e immediately available for review. Anew <br /> li application may be submitted when the File is available- <br /> 4. Any fife not returned in the same condition as released will be reorganized by EHD staff at the expenSQ <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 'TENTATW_E appointment dates must I.e confirmed with EHD Staff. <br /> 6. Applications received after 3:00 pm will.be processed the next business day. <br /> CIMh_,� r <br /> FEMT�NRPNM1r =)`- <br /> ' <br /> T <br /> }!PHONE FAX''kT <br /> REVIEWED YES NO REVIEW DATE <br /> : i <br />