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06/14/2005 14:18 209369" NEIL ANDERSON Et' 0 PAGE 02/0' <br /> EHD LOG NUVE <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL,HEALTH DEPARTMENT 304 E Weber Ave 3"Floor Stockton, CA 95205 - <br /> (209) 468-3420 Fax: (209) 464-0138 Web.www.co.san-joaquin.ca.us/chd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> I'pf'fIT/SF;`JII�ESAla <br /> c� c <br /> APPLICANT: _ �G�� _BUSINESSIAGENCY: <br /> ADDRESS: <br /> PHONE: 1 FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: D Time:_1_._ <br /> (Please allow 10 business days from date of application submitt'I <br /> a <br /> CHECK BOX TO EXPEDITE REQUEST-S 3.0o FEE EQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE I 65^' <br /> Department Use Only <br /> UNIT <br /> FILE ADDRESS <br /> 1.I 0/F ,. 11q�tel. SZ• S�. Gl ❑ unit 1 <br /> q"' I UiS 7. Street I W 0—i V• •S�+'t. v GL <br /> 7� i�� Clt El Unit 2 <br /> 1. Sl�t �1 <br /> Unit 3 <br /> S, street <br /> 6. SIM.& <br /> nit 4 <br /> 7. Ste cet <br /> U <br /> 0. Street <br /> 9. Slrrc( at ❑ Unit 5 <br /> 10. street G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 44 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) a FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(M OWTORINGIREM OVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR n CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> )!� TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILE <br /> D TATTOO/BODY PIERCING e ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> © MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. list up to ten addresses in the space above. <br /> the <br /> be selected f Fax tofrom <br /> 09the <br /> 464-0138above <br /> or myail to t <br /> the appropriate box(es). At least one file type MUST <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files 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 fi <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 w <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 exp( e <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to re, w. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIMI_ <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 4"7,00e <br /> eranoo� <br />