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04/15/2004 15:15 2094671118 AGE STOCKTON PAGE 01/F. <br /> 'DSAT£FtEEENE��'U �LJ .Mod <br /> SAN JOAQUIN COUNW EHD LOG NUMBER <br /> APR 15 2004 ENvjRoNMEN'TAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'd Floor Stockton,CA 95205 <br /> HkiWW 468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca.us/ehd s. <br /> J,�E�1!ICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Q BUSINESSIAGENCY:,OanCQhUIrM1w0A <br /> ADDRESS: O3!Z RAht 19hIckmil AA A f� J <br /> PHONE: Q y�7 iDa FACSIMILE: ?• T 1 ~ <br /> TENTATIVE"APPOINTMENT DATE: 0711a7miI= •* Qr a Ter <br /> iF <br /> (Ploase allow 10 bustnass days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQ ST-03.00 FEE—REQUE OCE SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICAN DATE 7 a� <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 490 J7 04C.. A <br /> CRY sro Cunit 1 <br /> 2. . a n )f - oZ V �r�j <br /> 3. .S C M • • ' hit 2 �•�q " <br /> I. S 3 is llti&h cft Al L. LJ <br /> 5. AT (� <br /> 6 aea � I&SJ M �+ Unit 3 <br /> CAY - unit4 <br /> e. sceet <br /> 9. S"e! 0 <br /> Unit 5 <br /> +o. say.+ C, / <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A13ATEMEMT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) G FOOD FACILITY Q SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINCIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT;. 11V TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YAR% <br /> ❑ TATTOOIBOOY PIERCING D POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ 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 idast one file type MUST be selected. Fax-to(209)464-0138 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. EffillIft <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMP-NT DATE... TIME, <br /> DATE CONFIRMED <br /> PHONE.: : . . FAX • INMALS <br /> REVIEWED .._ . YES NO. ... REVIEW DATE .. _ .: :.. ... . <br /> 654m-w <br /> VV2= <br /> l <br />